2009

Taiwan Public Health Report

Department of Health R.O.C. (Taiwan)

March 2010
Foreword

The responsibilities of the Department of Health,

the Executive Yuan (hereafter referred to as the
Department) are significant and extensive. They
cover the fields of public health, health promotion,
National Health Insurance, medical care and
rescue, management of pharmaceuticals, food
safety, disease prevention and monitoring, research
and development of biotechnology, and international
health affairs. They are highly related to the health
and welfare of the people; and any major decisions
thereof should meet the expectation of the people
about health.

The Department has always maintained, as

its vision for policy implementation, that it be a
navigator of the health for all to protect the physical
and mental health of the people, to shorten
disparities in health, to promote development in
biotechnology industries, and thus to become an
advanced nation in international health, with a view
to protect and promote the health of the citizens to
allow them to live longer and happier.

For the better understanding of what the health

organizations have done in the past years, this
Taiwan Public Health Report is published every
year. This volume, the 2009 Taiwan Public Health
Report, illustrates in detail of the health status,
policy implementation and achievements in 2008.
They are summarized as follows.

1. Advancement of medical care systems to

maintain the health of the people: a new hospital
 accreditation system focusing on medical
care quality has been established; work
in mental health is strengthened; care of
psychiatric patients in community is actively
promoted; prevention and control of suicide
is intensified; an electronic medical record
system has been promoted and criteria
of electronic medical records have been
formulated and maintained; special medical
care is strengthened; community-based long-
term care systems are set up, and work is
continued to promote the ten-year long-term
care plan; a tele-medical care program has
been piloted; and the working environment
for nursing personnel has been improved.
2. Realization of the preparedness of health
promotion and disease control to free the
public from threats of diseases: the existing
disease monitoring systems have been
strengthened; preparedness to face the
influenza epidemics has been completed;
work in the promotion of the plan to reduce
tuberculosis by half in ten years and the
harm-reduction program for drug addicts
against AIDS has been continued; prevention
and control of enterovirus infection and
dengue fever have been strengthened;
infection control in hospitals is strengthened;
a program of hand hygiene is implemented;
the overall national immunity has been
elevated; more items and target groups have
been included in the immunization program.
3. Promoting the core value of the National
Health Insurance to assure equality in
medical care; reform of the National Health
Insurance system has gone underway; work
is continued to promote plans to improve
payments for medical costs; medical care
quality indicators are made public; medical
care in remote areas is strengthened, and
care of the less privileged groups has been
extended; plans to help the economically-
deprived groups to pay for their overdue NHI
premiums have been implemented.
4. E n c o u r a g i n g t h e o v e r a l l p a r t i c i p a t i o n
of the public to realize healthy living: a
program,“move to live”, is advocated;
health fitness activities such as“walking ten-
thousand steps a day”are promoted; health-
supporting environments are built, and safe
community and safe schools are promoted;
a healthy city plan, health promotion at
worksites, and health promoting schools
are promoted; tobacco hazards prevention
is carried out to construct a smoke-free
environment; a high-quality supporting
environment for reproductive health is built;
a comprehensive care system for chronic
diseases has been constructed; cancer
control is realized to reduce the risks of
cancer.
5. Strengthening the management of food
and drugs to safeguard their safety: a
plan is currently ongoing to integrate the
management of food and drugs by creating a
Food and Drug Administration; the monitoring
and management of the safety of food is
strengthened; management of imported food
items is strengthened by more intensified
border inspection and reporting; safe drug
use environment is built; the prevention
and control of drug abuse is intensified;
management of Chinese medicine and
pharmacy is strengthened.
6. Active participation in international health
to link with the international community:
work has been done to join international
organizations, to promote exchange in
international health, and to promote medical
aid and technical cooperation to share
Taiwan's experience in health care.
To care for the patients of Hansen's disease,
the Department promulgated on August 13,
2008, a set of Regulations Governing Human
Rights Protection and Compensation for Hansen
Disease Patients. Action has then been taken
to restore the reputation of the patients, to
compensate their losses, to protect their rights
to medical and nursing care, and to substantially
care for their living.
In the summer of 2008, facing the
outbreaks on mainland China of incidents of
milk powder, ammonia powder and egg white
powder being contaminated by melamine,
an agreement on food safety was signed. To
strengthen the food and drug management
systems, in May 2009, the set of Regulations
Governing the Organization of the Food and
Drug Administration (TFDA) was passed. The
Administration is expected to be inaugurated
in January 2010. The new Administration can
more effectively enforce the management of
food, drugs and cosmetics to protect the health
of the people.
With the implementation of the amended
Tobacco Hazards Prevention Act on January
11, 2009, advancement in public health has
moved on one-step forward. Smoke-free
Taiwan is no longer a slogan. This is one of the
proud moments of the history of public health in
Taiwan. On January 22, 2009, the health and
welfare surcharge levied on tobacco products
was adjusted upward to NT$ 20, effective on
June 1.
In mid-April 2008, a novel H1N1 influenza
broke out in Mexico. The infection kept on
thereafter and gradually spread to all major
continents in the world, and Taiwan was no
exception. Information of the Centers for
Disease Control of the Department indicates
that the epidemic is moderate and stable as
yet, however chances of developing into a
major outbreak are there. The current disease
control strategy is not much so in containment,
but the main goals are to avoid large-scale
infection and at the same time, to reduce
mortality of the severe cases. We, therefore,
urge that the public take self-management of
health. The health authorities should prepare
in advance sufficient amount of vaccines and
Tamiflu, and adequate medical care capacities
and medical personnel. Over the nears, we
are fortunate that Taiwan has built a relatively
comprehensive medical care network and the
National Health Insurance; system-wise, Taiwan
has the capacity to face the epidemic. There
is never an end to disease control. There are
still outbreaks of enterovirus, dengue fever,
avian flu, and seasonal influenza that we are
confronted with. Each life is valuable. The
Department will continue to do its best in all
respects, and the cooperation of the public is
highly appreciated.
The National Health Insurance program
indeed is a great asset of Taiwan. It makes
accessible comprehensive medical care services
available to all. The international community
has given it high approval. Yet, a small portion
of the population is still unable to pay for the
insurance premiums. This is the area that more
effort is required. To reduce the burden of the
low-income families and the marginal families,
and to face the ever-increasing number of the
elderly and the critically ill patients, we wish
to adjust upward the insurance premium rate.
This intention comes out from consideration
of the welfare of the public. We hope that the
adjustment will be supported by all to assure the
sustainability of the National Health Insurance,
and thus to provide genuine protection to the
citizens of Taiwan.
Minister of Heath
Contents Foreword 2

Health Policies 8
1 Section 1 Goals and Focuses of Policy
Implementation in 2008 9
Section 2 Health Organization 10
Section 3 Health Budget 11
Section 4 Policy Evaluation 13

Health Indicators 14
2 Section 1
Section 2
The Population
Vital Indicators
15
16
Section 3 National Health Expenditures 18

Health Promotion 19
3 Section 1
Section 2
Community Health
Maternal and Child Health and
20
22
Reproductive Health
Section 3 Health Promotion for Children and 23
Adolescents
Section 4 Prevention and Control of Lifestyle- 25
Associated Chronic Diseases
Section 5 Prevention and Control of Cancer 28
Section 6 Tobacco Hazards Prevention 31
Section 7 National Nutrition 33
Section 8 Health Education 34

Communicable Disease Control 36

4 Section 1 Regulations and Frameworks for
Communicable Disease Control
37

Section 2 Control of Major/Emerging 42

Communicable Diseases
Section 3 Disease Control Preparedness and 46
Infection Control
Section 4 Immunization 49

Management of Food and Drugs 51

5 Section 1 Safety Management of Food and Drugs 52
Section 2 Management of Controlled Drugs 58
Section 3 Laboratory Testing for Drugs, Food 60
and Cosmetics
 Health Care 63
6 Section 1 Health Care Systems 64
Section 2 Quality of Medical Care 66
Section 3 Psychiatric Care and Mental Health 68
Section 4 Long-Term Care Service Systems 70
Section 5 Quality of Nursing Care 71
Section 6 Emergency Medical Care 72
Section 7 Health Information 72
Section 8 Medical Manpower 74

7
Health Care for the Less-Privileged 78
Groups
Section 1 Health Care for Residents of Mountain Areas 79
and Offshore Islands, the Indigenous Peoples
and the New Immigrants
Section 2 Health Care for the Economically-Deprived 82
Section 3 Health Care for Groups with Special Health Needs 83

8
National Health Insurance 87
Section 1 Current Status of the National Health Insurance 88
Section 2 Reform of the National Health Insurance System 93

International Cooperation in Health 94

9 Section 1 Joining the World Health Organization 95
Section 2 International Exchange and Cooperation in Health 96
Section 3 International Medical Aid 100

Science and Technology Research 101

10 Section 1 Projects Promoted with Priority 102
Section 2 General Science and Technology 103
Research Projects
Section 3 National Science and Technology 106
Research Projects
Section 4 Research Projects of the National Health 106
Research Institutes

Appendixes Health and Vital Statistics 115

 09︱Section 1 Goals and Focuses of Policy
Implementation in 2008

Health
1
10︱Section 2 Health Organization

Policies 11︱Section 3 Health Budget

13︱Section 4 Policy Evaluation

 1 Health Policies
The tasks that come under the responsibility
of the Department of Health, the Executive
Yuan (hereafter referred to as the Department),
medical care, disease control, health promotion,
management of food and drugs, research and
development in biotechnology, management of
health industries, the National Health Insurance,
and international health affairs, are closely
associated with the health and welfare of each
citizen. With limited resources and organization,
how to provide the people with all-directional
health care services to protect the health of all is a
major task of today.
Section 1 Goals and
Focuses of Policy
Implementation in
2008
The Department has, in accordance with the
2008 policy guidelines of the Executive Yuan, and
in coordination with the mid-term work plans and
the range of the approved budget, and focusing
on the current social conditions and the future
development needs of the Department itself,
formulated program plans for the year 2008. Their
goals and focuses are as follows.
1. To reform the health care systems, to upgrade
the quality of care, to promote holistic care, and
to construct a community health and medical
care system; to integrate and build a long-term
care system; to improve the quality of long-
term care services; and to advance the reform
of the National Health Insurance to make the
insurance system more comprehensive.
2. To build healthy life, and to promote self-
management; to create a smoke-free
environment by promoting an all-directional
tobacco hazards prevention; to urge the public
to establish healthy lifestyles to stay away
from cancer; to promote the screening of some
major cancers.
3. To strengthen the disease control systems to
avoid the threats of diseases; to strengthen the
functions of the current communicable disease
monitoring systems; to improve the monitoring
and reporting of diseases; to intensify
preparedness for influenza epidemics, and thus
to minimize the negative impact of influenza
epidemics on the health of the people.
4. To strengthen the management of food and
drugs to protect the safety of the people; to
improve the management systems for food
and drugs to ensure the safe use of food and
drugs; to plan for the integration and merging
of organizations of food and drug management
to consolidate management, laboratory testing,
and research in one unit.
5. To develop science and technology in medicine
Health Policies 09
 and pharmacy; to promote biotechnology and
health information industries; to promote the
development of bio-medicine industries; and
to develop manpower in health and medical
research.
6. To promote international health affairs; to join
the World Health Organization; to develop
international health networks; and to strengthen
international cooperation and exchange in
health and humanitarian aid.
Section 2 Health Organization
Organization of health administration came
originally in three levels, the central, provincial,
and county/city. Since the promulgation of the
Local System Act in 1999, the health organization
was reorganized into two levels, the central, and
the municipality and county/city (Figure 1-1).
The Department of Health of the Executive
Yuan at the central level is the highest health
authority in Taiwan to be responsible for the
health administration of the country, and also the
technical assistance, supervision and coordination
of local health agencies. In each of the two
municipalities, there is one city health department;
and in each county/city, there is a health bureau,
totaling 25. In each township, there is a health
station, totaling 372. They are responsible for the
administration of local health affairs.

Figure 1-1 Organization of Health Administration

The Executive Yuan

directly affiliated
Municipality governments County/City governments Department of Health
business association

Department of health (2) Health bureau (23)

District health center Township health station

Health room

10 2009 Taiwan Public Health Report

1. The National Health Administration
There are under the Department, bureaus
of Medical Affairs, Pharmaceutical Affairs, Food
Safety, Nursing and Health Care, International
Cooperation, and Planning, and several task-
oriented units such as the National Health
Insurance Task Force, Information Management
Center, Science and Technology Development,
and Hospital Management Committee. Affiliated
organizations under the Department include the
Bureau of National Health Insurance, Center for
Disease Control, Bureau of Health Promotion,
Bureau of Food and Drug Analysis, Bureau of
Controlled Drugs, Committee on Chinese Medicine
and Pharmacy, NHI Supervisory Committee,
NHI Dispute Mediation Committee, NHI Medical
Expenditure Negotiation Committee, 22 DOH
hospitals, six sanatoriums and one chest hospital.
In addition, there are also the DOH financially
supported units such as the Corporate National
Health Research Institutes, Corporate Center for
Drug Inspection and Examination, Taiwan Joint
Commission on Hospital Accreditation, Corporate
Foundation for Compensation for Drug Hazards,
and the Taiwan Organ Registry and Sharing
Center (Figure 1-2).
2. Planning for the Integration of the
Management of Food and Drugs
The safety, efficacy and quality of food,
drugs (western medicines, controlled drugs, bio-
products, medical devices, Chinese medicines,
and new drugs) and cosmetics are highly
associated with the daily life of the public and
also their medical care and welfare. Their
management systems and their efforts in the
management of the industries are an important
indicator of the health of the people.
In this connection, with reference to the
organization and management systems of food
and drugs in other countries, the Department has
a plan to integrate and merge the Bureau of Food
Safety, Bureau of Pharmaceutical Affairs, Bureau
of Food and Drug Analysis, Bureau of Controlled
Drugs, and the management of emerging bio-
medicine science and technology under the
Bureau of Medical Affairs to become a Food and
Drug Administration (TFDA) of the Department.
The new Administration will become an integrated
organization responsible for the administration,
laboratory testing and research of food, drugs,
and cosmetics, and the control of drug abuse.
The Organization Act of the Administration was
passed on June 3, 2009, and promulgated by the
Presidential decree.
Section 3 Health Budget
The health budget accounts for 3.1% of the
total central government budget (Figure 1-3). In
the last years, the budget of the Department has
not increased along with the aging of population
and the increased workload. However, the health
teams have continued to make all efforts to bring
health and safety to the people. In a public
opinion survey in 2008, the approval rate of the
performance of the Department was as high as
70%.
Health Policies 11
 Figure 1-2 Organization of the Department of Health, the Executive Yuan

Bureau of Medical Affairs

Bureau of Pharmaceutical Affairs

Bureau of Food Safety

Bureau of Nursing and Health Care

Bureau of National Health Insurance
Bureau of International Cooperation
Centers for Disease Control
Bureau of Planning
Bureau of Health Promotion
Secretariat
Minister
Bureau of Food and Drug Analysis
Personnel Office
Deputy Ministers Bureau of Controlled Drugs
Accounting Office
Committee on Chinese Medicine and Pharmacy
Chief
Secretary Statistics Office
NHI Supervisory Committee
Counselors
NHI Dispute Mediation Committee
Civil Service Ethics Office

NHI Medical Expenditure Negotiation Committee

Legal Affairs Committee

Hospitals(22)
Petitions and Appeals Committee

Sanatoriums (6)
National Health Insurance Task Force

Chest Hospital(1)
Information Management Center

Science and Technology Unit Corporate National Health Research Institutes

Health Eduction Promotion Committee Corporate Center for Drug Inspection and Examination

Public Relations Office Taiwan Joint Commission on Hospital Accreditation

Congressional Liaison Unit Corporate Foundation for Compensation for Drug Hazards

Hospital Management Committee Taiwan Organ Registry and Sharing Center

12 2009 Taiwan Public Health Report

 Figure 1-3 DOH Budget as Percent of Total Central Government Budget, 2001-2008

NT$ 10 million Central government DOH Percentage ％

180,000 3.5
162,835 168,586
157,548 160,833 157,178
156,480
160,000 151,872
155,025
3.2
3.1 3.0
3.0 3.0
140,000 2.8 2.8
2.7
2.6 2.5
120,000

100,000 2.0

80,000 1.5

60,000
1.0
40,000
0.5
20,000
4,723 4,217 4,225 4,348 4,159 4,692 5,165 5,242

0 0.0
2001 2002 2003 2004 2005 2006 2007 2008 Year

Section 4 Policy Evaluation health organizations with a view to help them

The promotion of health and medical care
requires the concerted cooperation of the central
and the local governments to effectively enforce
the relevant policies, and thus to protect the
health of the people. The Department's overall
evaluation over the achievements of local
health departments/bureaus aims primarily at
evaluating the annual performances of local
improve quality of services to the public. Since
2008, the Department has, based on the special
features of each county and city, integrated
and simplified the original evaluation into three
categories of“disease control and health
promotion”,“food and drugs”, and“medical
care”, to be executed by bureaus and divisions
concerned for evaluation and reward to upgrade
the administrative efficiency and quality.

Health Policies 13
 15︱Section 1 The Population

16︱Section 2 Vital Indicators

Health
2 Indicators
18︱Section 3 National Health Expenditures
2 Health Indicators
Along with increase in national incomes,
improvement in living environment and national
nutrition, advancement in health and medical
sciences, upgrading in health standards, and
increase in accessibility to medical care due to the
implementation of the National Health Insurance,
the average life expectancy of the people has
prolonged.
Section 1 The Population
At the end of 2008, the total registered
population in Taiwan was 23.04 millions. Of them,
11.63 millions were males and 11.41 millions were
females; giving a sex ratio (male population/female
population x 100) of 102. The annual growth rate
of population was 3.43 .
At the end of 2008, the population density in
Taiwan was 637 persons per square kilometer
of land area. By county and city, Kaohsiung City
had the highest density, and Taipei City came
next. Hualien and Taitung counties had the lowest
density.
1. Age Structure of Population
The population of Taiwan reached 20 millions
at the end of 1989. Upon the impact of the
declining birth rate year by year, the age structure
of population at the end of 1989 was already a
shrinking pyramid of low birth rate and low death
rate.
By the age structure of population, the
proportion of the aged population above 65
years to the total population reached 7% in 1993,
making Taiwan an aged society. The proportion
of the 0-14 young age groups had declined from
21.9% in 1998 to 16.9% in 2008. In the same
period, the proportion of the 65 years and above
elderly population had increased from 8.3% to
10.4%. The aging of population is becoming more
significant.
The dependency ratio (0-4 population + 65
and above population / 15-64 population x 100)
had declined from 43.3% in 1998 to 37.7% in
2008, due primarily to the rapid decline of the
young dependency ratio (0-14 population/ 15-
64 population x 100) and the steady increase
of the elderly dependency ratio (65 and above
population / 15-64 population x 100).
2. Births and Deaths
Fertility in Taiwan has declined year by year.
Crude birth rate (total number of live births in the
year / mid-year population x 1,000) had declined
from 12.4 in 1998 to 8.6 in 2008, a historically
low point. Crude death rate (total number of
deaths in the year / mid-year population x 1,000)
had increased slightly from 5.6 in 1998 to 6.3
in 2008, resulting in the decline of the natural
increase rate of population (crude birth rate –
Health Indicators 15
 crude death rate) to 2.3 in 2008 (Figure 2-1). adjustment is made by the age structure of the
2000 world standard population, the standardized
3. Life Expectancy death rate of 2008 is 484.3 per 100,000, a

Life expectancy at birth for both sexes in the decrease of 1.5% over the previous year.

last ten years had increased from 75.8 years in
1998 to 78.5 years in 2008, an increase of 2.7
years. For males in the same period, the life
expectancy at birth had increased from 73.1
years to 75.5 years, an increase of 2.4 years. For
females, it had increased from 78.9 years to 89.0
years, an increase of 3.1 years. The increase in
the life expectancy at birth for females is higher
than that of the males (Figure 2-2).
Section 2 Vital Indicators
1. Ten Leading Causes of Death
In 2008, the total number of deaths was
142,283 persons, giving a crude death rate
of 618.7 per 100,000 population, and was an
increase of 1.7% over the previous year. If
Changes in death rates seem to be significantly
affected by the aging of the age structure.
In 2008, the causes of death were coded by
the ICD-10. The ten leading causes of death
were malignant neoplasms, heart diseases,
cerebrobascular diseases, pneumonia, diabetes,
accidents and adverse effects, chronic diseases
of lower respiratory tract, chronic liver diseases
and cirrhosis, suicide, and nephritis, nephrotic
syndromes and nephrosis. Malignant neoplasm
remained as ever the first leading cause of death;
whereas accidents and adverse effects showed
the largest decline in mortality in recent years of
all causes of death (Figure 2-3).
2. Neonatal, Infant and Maternal Mortality
Rates
With the advancement in public health, both

Figure 2-1 Crude Birth Rate, Crude Death Rate, and Natural Increase Rate of Population by Year

‰
60

50

40

30 Crude Birth Rate

20
Natural Increase Rate
8.6‰
10
Crude Death Rate
6.3‰

0
1951 1956 1961 1966 1971 1976 1981 1986 1991 1996 2001 2006 2008 Year

16 2009 Taiwan Public Health Report

infant (deaths of infants under one year of age 2008, neonatal mortality rate had declined to
/ number of live births of the year x 1,000) and 2.7 ; this was about 44% of the mortality rate in
neonatal (deaths of infants under four weeks of
1971. In the same period, infant mortality rate
age / number of live births of the year x 1,000)
had dropped from 15.5 to 4.5. Furthermore, the
mortality rates have, with the slight exceptional
increase due to the practice of the new birth maternal mortality rate had declined from 39.7 per

reporting system in 1995, generally declined. In 100,000 in 1971 to 6.5 in 2008 (Figure 2-4).

Figure 2-2 Life Expectancy at Birth

Age
85 82.0
81.4 81.7
Male Female 79.9
78.1
77.1
75.9 74.9 75.5 75.5
74.6 74.1
75 72.1
73.6
72.4
71.0 71.8
69.7 69.7
68.7
66.8 67.2
65.2
64.4
65 62.3
60.4

56.3

55 53.4

45

35

25
1951 1956 1961 1966 1971 1976 1981 1986 1991 1996 2001 2006 2007 2008 Year

Figure 2-3 Changes in Ten Leading Causes of Death

2002 2008
Death rate from all causes 565.1 Death rate from all causes 618.7

Malignant neoplasms (cancer) 144.6 169.2 Malignant neoplasms (cancer)

Heart diseases 62.7 68.4 Heart diseases

Cerebrovascular diseases 47.5 46.4 Cerebrovascular diseases

Accidents and adverse effects 38.4 37.7 Pneumonia

Diabetes mellitus 31.7 34.9 Diabetes mellitus

Pneumonia 26.2 30.8 Accidents and adverse effects

Chronic diseases of lower respiratory tract 24.0 23.4 Chronic diseases of lower respiratory tract

Chronic liver diseases and cirrhosis 21.0 21.4 Chronic liver diseases and cirrhosis
Nephritis, nephrotic syndrome and nephrosis 16.3 17.9 Suicide

Suicide 13.6 17.4 Nephritis, nephrotic syndrome and nephrosis

180 160 140 120 100 80 60 40 20 0 0 20 40 60 80 100 120 140 160 180
Unit：Death rate per 100,000

Note: All causes for 2002-2008 are coded by ICD-10.

Health Indicators 17
 Section 3 National Health
Expenditures
The total national health expenditures for 2007 to 5.3% in 1995; and to 6.13% in 2007. In the
were NT$ 771.4 billions. In the year the National last ten some years, the average national health
Health Insurance was launched in 1995, the expenditures per persons had increased year by
proportion of national health expenditures to GDP year from NT$ 10,821 in 1991 to NT$ 33,661 in
of that year had increased from 4.9% in 1994 2007, an increase of 211.1% (Figure 2-5).

Figure 2-4 Neonatal, Infant and Maternal Mortality Rates

Neonatal and Infant Mortality Rates Maternal Mortality Rates

(per 1,000 live births) (per 100,000 live births)

18.0 60.0
Infant Mortality Rates Maternal Mortality Rates Neonatal Mortality Rates
15.5
16.0
50.0
14.0
39.7
12.0 10.6 40.0

10.0
29.5
30.0
8.0
6.7
6.2 6.3
6.0 20.0
4.7 4.5
4.1
3.5
4.0
9.4 2.9 2.7
1.00
2.0
2.1 7.7 7.8
6.5

0.0 0.0
1971 1976 1981 1986 1991 1996 2001 2006 2008 Year

Figure 2-5 NHE/GDP Ratios and Average Per Capita NHE by Year

NT$ ％
40,000 Average per capita NHE % of GDP 7.0
6.1 6.1 6.1
6.0 6.0 6.0 6.0
35,000 5.7 5.7 6.0
5.5 31,960 33,661
5.3 5.4 5.4
30,300
29,511
30,000 4.7 4.8 4.9
28,400
4.5 27,271 5.0
25,659 26,372
24,844
25,000 23,186
21,496 4.0
19,987
20,000 18,133

15,485 3.0
14,036
15,000
12,558
10,821 2.0
10,000

1.0
5,000

0 0.0
1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 Year

18 2009 Taiwan Public Health Report

 20︱Section 1 Community Health

22︱Section 2 Maternal and Child Health

and Reproductive Health

23︱Section 3 Health Promotion for

3
Health Children and Adolescents

25︱Section 4 Prevention and Control of

Promotion Lifestyle-Associated Chronic
Diseases

28︱Section 5 Prevention and Control of

Cancer

31︱Section 6 Tobacco Hazards Prevention

33︱Section 7 National Nutrition

34︱Section 8 Health Education

 3 Health Promotion
The World Health Organization advocates
that health should not be the mere absence
of diseases; it should focus on promoting the
development of overall health. The Department
has, therefore, promoted actively the building of
healthy life, improving self-management of health,
constructing healthy lifestyles, and, in coordination
with the early screening for diseases, to reduce
chronic diseases and their complications, and
to minimize diseases, disabilities and mortality,
and thus to attain the goal of health for all and
improvement of quality of life.
Section 1 Community Health
In the Alma-Ata Declaration in 1978, the WHO
strongly urged all nations to promote the health
of all and to attain the goal of health for all by
realizing primary health and medical care. Ever
since, the Department has actively promoted
primary care through health stations. Since
1999, the Department has, further in response
to the WHO Ottawa Charter of 1986, promoted
community health building projects with a view
to, through public participation, establish a
consensus and mechanism of community self-
building of health and to solve health problems of
communities.
20 2009 Taiwan Public Health Report
1. Upgrading the Service Quality of Health
Stations
Health stations are the primary operational
units in Taiwan's healthcare service systems. At
the end of 2008, there were 372 township health
stations, including the 12 district health service
centers of Taipei City, to provide the public with
continuous, integrated and comprehensive
primary care services. Some major achievements
are as follows.
1) T h e T h i r d G o l d e n S t a t i o n A w a r d w a s
organized; the manpower development plan for
administrative inspection of health station was
implemented. A set of high-quality standard
operational procedures for health stations and
benchmark learning are promoted to upgrade
the service quality.
2) A 2007 Annual Statistical Report of Health
Stations by County/City containing information
on the current status of service manpower,
hardware facilities and services of all health
stations is compiled and published.
3) A project is implemented to augment the
functions of the health and medical care
information systems of health stations and their
maintenance to improve the efficiency of the
out-patient medical care systems.
2. Physical Activity and Healthy Body promotion networks: Through diversified
strategies of promotion, 861 stores and 1,475
The public is encouraged to take part in
community groups are organized together to
physical activities to build healthy lifestyles. Major
jointly promote issues on healthy diet, health
activities are:
fitness, tobacco hazards prevention, betel-nut
1) S i n c e 2 0 0 6 , N o v e m b e r 1 1 i s m a d e
prevention, health promotion for adults and the
the“National Walking Day”. The reason
elderly, and safe community.
for choosing November 11th is because of
2) To promote healthy city and health promoting
its resemblance to two pairs of feet walking
hospital projects: By the end of 2008, Tainan
together. The public is encouraged to build
City, Hualien County, Miaoli County, Daan,
up a health concept of walking to promote
Shilin and Beitou Districts of Taipei City, and
health. The public is encouraged to build up
Tamshui Township of Taipei County had
a health concept of walking to promote health.
successfully become members of the WHO
The“Ten thousand steps a day makes you
Western Pacific Region AFHC (Alliance
healthier”is advocated to encourage the
for Healthy Cities). Taiwan's experience in
people for regular exercise.
promoting healthy cities was shared at the 3rd
2) To promote healthy walking in communities WHO Western Pacific AFHC general meeting
and work places, various activities such and the international symposium.
as a symposium on dynamic community
environment, healthy walking, painting and 4. Health Promotion at Workplaces and
essay contests for children, promotion of Management of Health Risks
healthy walking by enterprises, and physical
Facing the globalization of enterprises and
exercises for office workers have been
diversification of employment patterns, Taiwan's
organized in coordination with enterprises,
promotion of occupational health has shifted
communities, schools and the health bureaus.
from the control of occupational diseases in
the past to health promotion at workplaces. In
3. Promoting the Community-Based Healthy
addition, through cross-ministerial collaboration,
Life Plan
comprehensive policies are formulated to tackle
The“community-based healthy life plan”aims the impact of health risks posed by environmental
at, through the operation of community pollutions.
organizations, motivating the public to change
1) 74 workplaces have been given assistance
from the conventional passive acceptance of
in health promotion and tobacco hazards
healthcare service to active participation and care
prevention by professional groups. A project
for their own health, and to practice healthy living.
for the self-certification of healthy workplaces
Major activities are:
is implemented and assessment standards are
1) To c o n s t r u c t c o m m u n i t y - b a s e d h e a l t h decided. In total, 1,177 workplaces have been

Health Promotion 21
 qualified.
2) To understand the health hazards brought
about by environmental pollutions, cross-
ministerial coordination and health risk
assessment meetings are held. At these
meetings, issues related to health risks (such
as electromagnetic) and their management
are discussed. The matter of electromagnetic
is managed through cross-ministerial
cooperation.
Section 2 Maternal and
Child Health and
Reproductive Health
A comprehensive service system in maternal
and child health and reproductive health is
constructed to ensure every pregnant woman be
in good health and every child be born safely and
to grow in good health thereafter.
1) To improve the quality of healthcare for
pregnant women, pregnant women are offered
10 free prenatal care services. Each pregnant
woman is given a health handbook.
2) Breastfeeding friendly environments are set up
all around. Work is continued to certify Baby
Friendly Hospital Initiative（BFHI）. In 2008,
94 institutions had passed the certification.
Communities are encouraged to train breast-
feeding promotion volunteers and to organize
supporting groups. Free counseling services
are offered. Websites on breast-feeding are
set up. In coordination with county/city health
bureaus, workplaces are encouraged and
supervised to set up mother's breastfeeding
22 2009 Taiwan Public Health Report
rooms.
1. Health Promotion for Infants and Young
Children
1) To strengthen healthcare for infants and young
children, 9 preventive examinations are offered
free to children less than seven years of age.
Parents are offered a Child Health Handbook
to provide them with knowledge on preventive
care of children.
2) Taiwan is the first country in the world to
conduct mass screening for infant with
cholestasis using a“stool color card”. In
2008, computer registration systems had
been completed in all health bureaus, medical
centers and 74% of district hospitals. In total,
221,823 person-times of children have been
screened. Of them, 107 children are reported
abnormal in the color of their stools; and of
them, 14 are confirmed biliary atresia.
3) To i m p r o v e t h e s c r e e n i n g o f c h i l d r e n
w i t h d e v e l o p m e n t a l d e l a y, a p r o j e c t o f
developmental screening for children under
3 was conducted in 2008. A total of 323,929
children were screened. Of them, 4,754
children were suspected abnormal; and 3,574
of them had been reported and referred.
2. Reproductive Health
1) The Genetic Health Act was legislated in 1985,
with a view to attain the goals of“protecting
the health of mothers and children and
improving welfare of families.”Measures in
promoting reproductive health and examination
for several genetic disorders have been
planned and promoted throughout the country.
 These measures include pre-marital health
examination, prenatal genetic diagnosis,
screening of the newborns, and genetic
counseling, to reduce congenital anomalies in
next generations.
2) More than 98.7% of the newborns had been
screened for congenital metabolic disorders
in 2008, to find 4,082 abnormal cases. In
2008, 33,396 pregnant women had been
subsidized for prenatal genetic diagnosis, to
find 774 abnormal cases. More than 85%
of pregnant women aged 34 and above had
received amniocentesis. 11,377 persons
suspected of genetic disorders themselves
or their family members had been further
examined for genetic disorders, to find 4,589
abnormal cases. Costs for such services were
either waived or subsidized by the Regulations
Governing Waiving or Subsidizing for Costs
for Genetic Health Measures. Abnormal cases
are followed-up and given health education.
3. Technical Development of Artificial
Reproduction
1) To promote the development of artificial
reproduction and to protect the rights of infertile
couples, the artificial reproduction child, and
donors, the Artificial Reproduction Act was
promulgated on March 21, 2007. Regulations
for Query on Kinship of Artificial Reproduction
Child, Regulations for Artificial Reproduction
Institution Permit, and Regulations for Artificial
Reproduction Information Notification and
Administration have been announced one by
one. In collaboration with the Ministry of the
Interior, a set of Regulations for Verification
on Kinship of Sperm/Oocyte Donors and
Receptors was announced.
2) To upgrade the service quality of artificial
reproduction institutions, and to serve as a
reference for infertile couples in identifying
institutions for medical care, review for
permission of artificial reproduction institutions
is continued. By the end of 2008, 75 such
institutions had been given permission.
Section 3 Health Promotion
for Children and
Adolescents
Work is done to strengthen the prevention
of accidents and injuries, hearing health, visual
health, and sexuality health for children and
adolescents. A health promoting school project
is promoted. The goal is to allow each child and
adolescent to have sound physical and mental
development and to lead a healthy living.
1. Prevention of Accidents and Injuries and
Safety Promotion
In the last ten years, mortality of accidents and
injuries has, with the exception of the September
21 earthquake, declined gradually, to 35.1 per
100,000 in 2006, and to 30.8 per 100,000 in 2008.
Achievements in this respect are summarized as
follows.
1) Through the health bureaus and community
health building centers of the 25 countries
and cities, inspection of home safety is
conducted. Households are supervised to
make improvement.
Health Promotion 23
 2) Work has been extended to 20 counties and
cities to provide children of the new immigrants
with care in the prevention of accidents and
injuries.
3) A s a f e c o m m u n i t y n e t w o r k i s s e t u p .
Promotion centers for community safety
and four supporting centers in the northern,
central, southern and eastern regions have
been established since 2006. By the end of
2008, seven communities had passed the
international verification.
4) An indigenous safe school model is promoted.
By the end of 2008, 15 schools had passed the
international verification.
2. Oral, Vision and Hearing Health
1) Oral Health Promotion
Findings of national oral health surveys of
children and adolescents conducted every five
years show that the DMFT index had declined
from 3.31 teeth in 2000 to 2.58 teeth in 2006,
and is expected to decline to 2.2 teeth in 2010.
The decline is due primarily to the decrease in
the number of decayed and missing teeth.
Free fluoride application of teeth twice
a year is given to children under five years
of age. In 2008, 221,260 person-times of
children had been given this service. Mouth-
rinsing with fluoridated water for the prevention
of dental caries for primary school children
is promoted universally. Some 1.75 million
school children in 2,651 primary schools in
25 counties and cities had taken part in this
project, at a participation rate of 98.5%.
24 2009 Taiwan Public Health Report
2) Vision Health
Epidemiological surveys of school children
6-18 years for myopia rate conducted every five
years show that the increase of the prevalence
of myopia for primary school children had
slowed down since 2006. However, the myopia
rate of the first year primary school children is
as high as 20%; prevention of myopia should
begin earlier in pre-school age children.
(1) A vision health promotion advisory group is
set up to consider strategies for the health
education of caregivers of pre-school age
children.
(2) A national action plan for the screening
of pre-school age children for strabismus,
amblyopia and vision has been conducted.
In total, 341,796 children have been
screened, giving a preliminary abnormal
rate of 14.5%. 99% of them have been
referred and corrected.
3) Hearing Health
A project to screen hearing of the newborns
and to assess their effects is implemented.
Four service centers are set up in the northern,
central, southern and eastern regions to assist
collaborating medical care institutions to
provide the newborns with hearing screening
services. A project to provide services to the
pre-school age children for the screening
of hearing and language impairment is also
conducted. Young children confirmed of
hearing disorders are followed-up for correction
and management. Caregivers of children with
articulation problems are given counseling.
 Health education materials on hearing and
language impairment and discs on articulation
teaching are offered to pre-school age children.
3. Sexuality Health Promotion for Children
and Adolescents
1) A website for children and adolescents on
sexuality is set up to provide them with correct
information on sex and contraceptive methods.
In 2008, the website had been visited 400
thousand person-times.
2) 13 hospitals and the Master Chang Foundation
are subsidized to implement a project in eight
county/city service areas to provide health
promotion services to children and adolescents
in the diagnosis, counseling and supervision
on physical and mental health problems.
3) A project, children and adolescents-friendly
outpatient clinic, is implemented. Medical care
institutions are coordinated to set up clinics for
the teens to provide them with contraceptive
methods; to help them communicate with
their parents on issues such as unexpected
pregnancy; and thus to promote and protect
the reproductive health of children and
adolescents.
4) A project for community pharmacies to promote
counseling services in sexuality for children
and adolescents is conducted. 150 community
pharmacies have taken part in this project to
provide contraception and sexuality health-
related counseling to the youths.
4. Health Promoting Schools
In 2008, 3,868 senior high/vocational schools
and under had become health promoting schools.
By their own needs, schools promote issues
such as tobacco hazards prevention on campus,
school safety, betel-nut prevention, vision health
promotion, oral health promotion, health fitness,
and sex education.
1) The number of health promoting schools had
increased from 318 in 2005 to 3,868 in 2008.
25 counties and cities have been supervised
to set up local supervisory groups. A pilot
project on tobacco hazards prevention on
campus was conducted in five primary, junior
high and senior high/vocational schools in two
counties. Training of manpower and seed
workers has been conducted. Indicators for
the assessment of project achievements have
also been developed.
2) A single-entry website has been set up to
provide real-time information and online
supervision.
Section 4 Prevention and
Control of Lifestyle-
Associated Chronic
Diseases
Since Taiwan became an aged society in
1985, the problem of population aging is getting
worse. In addition, with changes in lifestyles and
the westernization of diet, chronic diseases have
increased year by year. Diabetes, cardiovascular
diseases and kidney diseases are now on the
list of the ten leading causes of death. With the
aging of the population and the implementation
of the National Health Insurance, costs for
Health Promotion 25
 hemodialysis are now a heavy financial burden
of the National Health Insurance. To minimize
the threats of chronic diseases, programs have
been implemented following the three-stage and
five-level principles of public health. Some major
achievements are as follows.
1. Preventive Health
Preventive health care can secure all national
health by early disease detection and early
treatment. Since 1995, DOH has provided 4
main preventive health care services, which are
prenatal examination, children's preventive health
examination, cervical Pap smear examination,
and adults' preventive health examination.
Mammography X-ray examination and fluoridation
of teeth for children were added in 2004. Items
of the preventive healthcare services are listed in
Table 3-1.
2. Health Promotion for High-Risk Groups
High-risk groups of various chronic diseases
are early identified to provide them with health
promotion activities and thus to avoid or delay the

Table 3-1 Health Screening Services and Utilization Rate in 2008

Utilization Rate (%)

Category Target Group Frequency Items of Examination
in 2008

Physical, laboratory,
Prenatal care Pregnant women 10n Ultra-sound and health 1.74 millions (97.2%)
education

Preventive Physical, development

healthcare for Children under 7 years 9n diagnosis and health 1.24 million (68.6%)
children education

Dental fluoridation by
Dental fluoridation Once/six dentists, general oral
Children under 5 years 220,000 (13.2%)
for children months cavity examination and
health education

Specimen collection,
pelvic examination, and
Pap smear test Women above 30 years Once/year 1.82 million (26%)
pathological examination
of cervical cells

Once/two Mammography
Mammography Women 50-69 years 160,000 (6.6%)
years examination

Once/three
Persons of 40-65 years
years
Preventive Physical examination,
healthcare for Persons 65 and above Once/year health counseling, blood 1.70 million (34.2%)
adults test and urine test
polio cases and above
Once/year
35 years
Note: Rates of persons newly detected of blood pressure, blood sugar and cholesterol disorders are 22.7%, 7.8% and
13.1% respectively.

26 2009 Taiwan Public Health Report

occurrence of diseases.
1) Metabolic Syndromes
Diversified methods and media, such as
radios, contests of school teachers, parents and
students, workshops for teachers and the printing
of educational materials are used to promote the
prevention of metabolic syndrome.
2) High-Risk Groups of Diabetes
(1) In coordination with the theme of the 2008
World Diabetes Day of the United Nations,
lights were lit at the landmark buildings and
fairs were held. Achievements of Taiwan in
the l prevention of diabetes were posted on
the websites of the United Nations and the
International Diabetes Federation.
(2) Wo r k h a s b e e n d o n e o n t h e h e a l t h
promotion for diabetes high-risk groups by
136 diabetes health promotion institutions
and 239 diabetes patients and families self-
help groups in 217 communities.
3) High-Risk Groups of Chronic Kidney
Disease
A project for the prevention of chronic
kidney diseases at the primary care level was
carried out. In total, 317 screening sessions
for 49,342 persons were conducted. Among
them, 2,807 persons were identified as chronic
kidney disease patients in phases 1 to 5. 12
training sessions were organized for 942
medical and nursing personnel. Educational
materials for chronic kidney disease prevention
in Paiwan language were produced. A portable
GFR calculator was developed.
4) Health Promotion for the Elderly
(1) Work is continued to promote issues related
to the health promotion of the elderly such
as health physical fitness, healthy diet, fall
prevention, oral cavity and visual health,
smoking-cessation, screening for cancer,
and prevention of chronic diseases.
(2) Strategies for the prevention of blindness of
adults and the elderly have been studied.
A simplified screening questionnaire
and a tool for eye disease screening in
community have been developed. Eight
hospitals have been subsidized to conduct
visual health promotion projects in areas
short of ophthalmologists to screen adults
and the elderly for vision, and to give health
education on eye diseases.
(3) In two counties and cities, a resource-
integrated model for the health promotion
of the elderly in community is tried out. In
20 communities in 14 counties and cities,
a health promotion project for the elderly in
community is implemented.
(4) A four-year plan for the health promotion
of the elderly (2009-2012) is developed
to promote eight items in health fitness,
diet, fall prevention, oral healthcare,
smoking-cessation, mental health, social
participation, preventive health, and
screening services.
(5) Fall prevention and home safety for the
elderly are promoted. In 85 community
health building centers, work has been
carried out to inspect and improve home
safety.
3. Upgrading Care Standards
1) Development of Educational Materials
Health Promotion 27
 English, Vietnamese and Indonesian
versions of the educational materials on
diabetes, stroke, kidney diseases and chronic
obstructive pulmonary disease (COPD) have
been produced for alien caregivers and
spouses.
2) Shared Care Network for Diabetes
The shared care network for diabetes is
promoted. 1,869 medical care institutions take
part in this project. To improve the quality of
medical personnel in the care of diabetes, a
certification system for physicians, nurses and
dietitians has been established. To improve
the quality of care for diabetes, field practice of
health education personnel has been arranged
in diabetes health promotion institutions.
Smoking-cessation counseling is provided.
Improvement in the pay schedule for diabetes
under the National Health Insurance is made.
The diabetes patients-supporting system
is strengthened to improve the efficiency of
436 diabetes patients self-help groups. The
Taiwanese Association of Persons of Diabets
has been set up.
3) Care for Cardiovascular Diseases
More blood pressure measurement stations
in communities are set up. By the end of 2008,
there were 463 blood pressure measurement
stations. About 3,000 cases throughout the
country are urged to take blood pressure at
home for ten days. A stroke registry system
is set up; and since 2006, 38 hospitals have
joined the project to register 30,000 some
stroke cases. A low-salt project is implemented
to advocate“no more than 6 grams of salt
per day (no more than 2,400 milligrams of
28 2009 Taiwan Public Health Report
sodium)”. The public is reminded, before
buying packed food, to check the sodium
contents on the packing lable.
4) Care for Chronic Kidney Diseases
To slow down the progress of CKD (chronic
kidney disease), a multi-disciplinary, cross-
discipline care model was developed. 77
kidney health promotion institutions have been
set up, and 14,068 new cases were accepted.
Throughout the year, 31,074 cases were
accepted totally. Among the end stage renal
disease patients, 2,104 cases have received
treatment including hemodialysis, peritoneum
dialysis, and kidney transplantation. Among
them, 22.6% of patients have accepted
peritoneum dialysis; 38.9% of those who have
accepted hemodialysis the first time are served
at outpatient but not through hospital care or
emergency care.
Section 5 Prevention and
Control of Cancer
1. Current Status of Cancer
By the statistics of cancer registry in 2006,
the number of new cancer cases (not including
carcinoma in situ) in the year was 73,293 (42,017
males and 31,276 females). The crude incidence
rates of males and females were 362 and 277
per 100,000 respectively. If adjusted by the WHO
2000 world standard population, the standardized
incidence rates for males and females were 310
and 229 per 100,000 respectively. The commonly
seen five leading cancers for men and women are
shown in Table 3-2 and Table 3-3.
2. Reducing Risks to Cancer task of cancer control in all countries.

The National Cancer Control Program 2002 1) Betel-Quid Hazards Prevention

of the World Health Organization stipulates that The incidence and mortality of oral cavity
primary prevention of cancer can reduce at least cancer have increased the most drastically
30% of cancer cases. Therefore, reduction of in all cancers of men. In Taiwan, betel-quid
exposure to carcinogenic factors is one important chewing is the most important cause of oral

Table 3-2 Incidence of Five Leading Cancers in Men, 2006 (not including carcinoma in situ)

Crude Incidence Age-Standardized Incidence

Site No. of Cases
(per 100,000) (per 100,000)

Liver and intrahepatic bile

7,617 62 54
ducts

Colon and rectum 5,793 50 43

Lung, bronchus and trachea 5,756 50 42

Oral cavity, oropharynx and

4,879 42 36
hypopharynx

Prostate 3,073 27 22

Others 14,899 - -

Total 42,017 362 310

Table 3-3 Incidence of Five Leading Cancers in Women, 2006 (not including carcinoma in situ)

Crude Incidence Age-Standardized Incidence

Site No. of Cases
(per 100,000) (per 100,000)

Female breast 6,895 61 50

Colon and rectum 4,455 40 32

Liver and intrahepatic bile

2,925 26 22
ducts

Lung, bronchus and trachea 2,992 27 22

Cervix invasive cancer 1,828 16 13

Others 12,181 - -

Total 31,276 277 229

Health Promotion 29
 cavity cancer. To control the hazards of betel-
quid, the Department, in addition to educating
the public on the hazards of betel-quid chewing
through all kinds of media, efforts have also
been made in all areas. Since 2008, in the
health promoting school project, schools may
decide, upon actual needs, to include in the
teaching skills to refuse betel-quid chewing.
The armies are made betel-quid free. In
communities, in collaboration with private
sector organizations, fight against betel-
quid chewing is advocated. Through health
bureaus and private sector organizations,
130 high betel-quid chewing workplaces have
been assisted to build betel-quid free work
environments. By years of hard work, in 2008,
the betel-quid chewing rate in males 18 years
and above had dropped to 15%.
2) HPV Vaccine
In 2006 and 2008, the Department
approved the marketing of two types of HPV
(human papilloma virus) vaccines. To make
the public understand better HPV vaccine
and the control of cervical cancer, educational
materials for different age groups have
been produced. To study policies regarding
HPV vaccine, a telephone survey of parents
agreeing daughters 9-15 years to accept
cervical cancer vaccine, and a questionnaire
survey of the knowledge and attitude of
parents of junior high school daughters on
cervical cancer vaccine have been conducted.
A symposium was organized to discuss issues
of whether public funds should be used to
subsidize cervical cancer immunization to
collect opinions of different groups on the
30 2009 Taiwan Public Health Report
issues of HPV. At the end of 2008, experts and
scholars were called to compile an assessment
report on the policies of HPV.
3. Early Detection of Cancer
1) Cervical cancer screening: Work began in
July 1995 to provide women 30 years and
above with one Pap-smear examination
each year. Findings of a telephone survey
in 2008 conducted by the Bureau of Health
Promotion of the Department show that 70% of
women 30-69 years had had one Pap-smear
examination in the past three years. Database
of the Pap-smear screening report shows that
56% of women have had Pap-smear screening
in the past three years. Pap-smear screening
has reduced the incidence and mortality of
cervical cancer by almost 50%.
2) Female breast cancer screening: In the period
between July 2002 and June 2004, a project
to screen women 50-69 years for breast
cancer in two stages was tried out. Beginning
in July 2004, women 50-69 years are given
mammography screening once every two
years. In the past two years, 288,000 women
have accepted the mammography screening,
at a screening rate of 12%. About 50% of the
breast cancer detected through mammography
is either at the 0 or 1st stage, indicating that
screening is useful in the early detection of
breast cancer.
3) C o l o n a n d r e c t u m c a n c e r s c r e e n i n g :
Since 2004, people aged 50-69 years are
encouraged to accept fecal occult blood test.
In the last two years, some 480,000 persons
have accepted the test, at a screening rate of
 10%. About 40% of the colon-rectum cancer
detected through the screening is either at
the 0 or 1st stage, indicating that screening is
useful in the early detection of colon-rectum
cancer.
4) Oral cavity cancer screening: Since 1999,
examination of oral cavity membrane is offered
to the smoking or betel-quid chewing groups
18 years and above. In the last two years, 1.04
million people have accepted the examination,
giving a screening rate of 25%. Of them, 632
persons are confirmed oral cavity cancer.
4. Upgrading the Quality of Cancer Diagnosis
and Care
1) The Bureau of Health Promotion of the
Department announced on October 4, 2007,
the Standards of the Quality of Cancer
D i a g n o s i s a n d Tr e a t m e n t i n 2 0 0 8 , a n d
Operational Procedures for the Quality of
Cancer Diagnosis and Treatment. Work began
in 2008 to conduct accreditation of cancer
diagnosis and treatment by the announced
standards for hospitals with 500 and more new
diagnosed cancer cases. In 2008, 22 hospitals
had been successfully certified. Results of the
accreditation are announced for the reference
of the public in seeking medical care.
2) Hospice and palliative care has been promoted
since 1995. By the end of 2008, there were
34, 59 and 65 hospitals providing hospice care,
hospice home care, and hospice shared-care
respectively. In 2008, the hospice shared-care
had served 13,900 some cancer patients.
3) T h e u s e o f h o s p i c e a n d p a l l i a t i v e c a r e
(including hospice care, hospice home care
and hospice shared-care) of cancer patients in
the year prior to their death is analyzed by the
death tolls and claims for the National Health
Insurance. The use rate had sharply increased
from 7.4% in 2000 to 31.8% in 2007.
Section 6 Tobacco Hazards
Prevention
For the prevention of tobacco hazards, the
Tobacco Hazards Prevention Act was implemented
in 1997. A health and welfare surcharge was
levied on tobacco products in 2002; the surcharge
was adjusted to NT$ 10 per pack of cigarettes in
2006. Of the surcharges, 3% is used for tobacco
hazards prevention. A telephone survey of the
smoking behavior of adults in 2004 through 2008
shows that the smoking rates of adults 18 years
and above are 42.9% for men and 4.6% for
women in 2004; 40.0% and 4.8% in 2005; 39.6%
and 4.1% in 2006; 39.0% and 5.1% in 2007;
and 38.6% and 4.8% in 2008. Data of the past
years show that the smoking rate of men shows
a declining trend; whereas the smoking rate of
women is under close observation.
1. Smoke-Free Environment
The main goals of the tobacco hazards
prevention are to reduce the smoking rate
and to minimize the exposure rate to second-
hand smoking in public places. Smoke-free
environment, is promoted in communities,
restaurants, schools, workplaces and the armies.
Major activities are:
1) promoting 30 smoke-free communities;
92 groups have joined the project; and
Health Promotion 31
 4,600 families are now smoke-free. 12,452 videos of 25 county/city mayors advocating
restaurants are made smoke-free. smoke-free public places are made; contests
of individualized no-smoking signs for public
2) In collaboration with the Ministry of Education,
transportation means and restaurants are
3,868 senior high/vocational schools, junior
held. Through the use of public and private
high schools, primary schools and 48
sector resources, efforts are made to advocate
universities and colleges took part in this
the new regulations of the Tobacco Hazards
project.
Prevention Act, the hazards of second-hand
3) In 2008, 74 workplaces had been supervised
smoking, and other information relevant to
on the spot to promote either smoke-free or
tobacco hazards and smoking-cessation.
smoke-restriction policies. The survey on
A survey in December 2008 soon after the
tobacco hazards in workplaces commissioned
educational activities shows that 90% of the
out by the Department indicates that the
public know about the new regulations of
smoking rate of employees is 20%; and the
no-smoking in public transportation means,
exposure rate to second-hand smoking indoors
indoors workplaces of three persons and more,
of workplaces is 26%.
and in public places.
4) In collaboration with the Ministry of Defense,
7) Non-Smoking Express mobile exhibition
tobacco hazards prevention policies in armies
delivers the messages of tobacco hazard
are formulated; smoking-cessation intervention
prevention on campus. This exhibition is held
services are offered; and research and
alternately in 17 senior high and vocational
monitoring on tobacco hazards prevention are
schools during one and a half year. This
also conducted.
exhibition shows the impacts of smoking to
5) T h e i n t e r n a t i o n a l s m o k i n g c e s s a t i o n economy, appearance and relationships,
campaign,“Quit and Win 2008”, has been and also the plots of tobacco companies in
launched since April in Taiwan. The event is marketing of tobacco products. In a ten-minute
open to adults over 18 years old who have break or after school study, the students can
smoked for more than a year, with each spend some time to attend this Non-Smoking
participant requiring one person to serve Express at school.
as a witness. There are 18,741 participants
to this year's quit and win campaign who 2. Diversified Smoking-Cessation Services
have promised trying not to smoke from May
Article 21 of the amended Tobacco Hazards
2nd to 29th.“Throw Away Your Cigarettes
Prevention Act and Article 14 of the WHO
Design”competition was held at the same
Framework Convention on Tobacco Control
time. Prize winners are promoted on
stipulate that to assist smokers quit smoking is a
commercials networks and movie theaters.
major task of countries in the control of tobacco
6) Through the use of diversified media channels, hazards.

32 2009 Taiwan Public Health Report

1) Out-patient smoking-cessation therapy:
Currently there are 2,149 medical care
institutions distributed over 357 townships and
districts (97%). In the period 2002 through
2008, a total of 360,957 people have accepted
the services; 42,857 people accepted the
services in 2008 alone. The six-month
cessation success rate was about 22%.
2) Smoking-cessation help-line: A project,
smoking-cessation counseling line, began
in 2003. Toll-free (0800-636363) counseling
services are offered by specialists in
psychological counseling. By the end of 2008,
the service received 340,000 enquiries; In
2008, counseling services received 76,800
enquiries. For those who have accepted
counseling for several times, the group's six-
month cessation success rate was about 29%.
3. Amendment and Enforcement of the
Tobacco Hazards Prevention Act
The Tobacco Hazards Prevention Act has
been amended following the principles of the
WHO FCTC (Framework Convention on Tobacco
Control). The Amendment was passed by the
Legislative Yuan in June 2007; promulgated by the
President of the Republic on July 11 of the same
year; and will come into effect officially on January
1, 2009. This is one step further in protecting
the health of the people and in the prevention of
tobacco hazards as well.
To enforce the Tobacco Hazards Prevention
Act, several important activities have been
carried out. They are: 696 temporary workers are
employed to help counties and cities in inspection
and site-visiting; in 2008, a total of 215,000 firms
had been inspected to find 12,530 violations.
Tickets had been issued to 8,275 violations, and a
total of NT$ 2,256,000 in fines had been collected.
In the management of public complaints and
counseling, 463 complaints have been received,
and 369 cases have been offered counseling. A
survey on the achievements in the enforcement of
the Act is held. The average pass rate is 91.4%.
Professional skills of employees are strengthened
through workshops, training courses and teaching
manuals.
Section 7 National Nutrition
Chronic diseases such as cancer, stroke, heart
diseases, diabetes and hypertension are highly
associated with. Therefore, to build a healthy
and balanced diet concept in the population,
to promote a healthy diet life, and to reduce
the occurrence of chronic diseases are current
important tasks that are to be actively promoted.
1. National Nutrition and Health Surveys
To periodically monitor the nutrition status
of the population, the third national survey on
changes in health status and nutrition in 2004-
2008 was conducted, focusing on infants and
young children 6 years (inclusive) and less and
adults 19 years (inclusive) and above. The
survey includes a questionnaire interview on
dietary consumption, KAP (knowledge, attitude
and practice) of nutrition, and various nutrition-
associated diseases, and health examination to
understand the nutrition problems and nutrition-
associated diseases in different age groups
for reference in the establishment of nutrition
Health Promotion 33
 improvement action plans and nutrition policies.
Household survey and health examination
began in July 2005. In this survey, the computer
assisted personal interview (CAPI) system was
used the first time; and the dual energy X-ray
absorptiometry (DEXA) mobile vans went around
for bone density examination. In total, 6,189
persons had been questionnaire-interviewed and
3,670 persons had been given health examination.
2. Nutrition Labeling
In recent years, people have become more
aware of nutrition and health, many developed
countries have enforced the nutrition labeling
on packaged food. To meet the demands of the
public, to build in consumers correct knowledge
of nutrition labeling, and to provide them with
sufficient information when they are selecting
and buying food, the nutrition labeling system for
packaged food on market has been promoted.
The nutrition labeling system in Taiwan has
been promoted step by step with the active
involvement of the manufacturers. The labeling
requirements are announced one by one by food
items. In 1998, the principles of nutrition labeling
that packaged food on market should comply with
were announced. The principles regulate that
packaged food showing nutrition claim should
provide with nutrition labeling. Since January 1,
2008, all completely packaged food products on
market are required of nutrition labeling.
In Taiwan, nutrients that are required of
mandatory labeling include energy, protein,
fat, saturated fat, trans-fat, carbohydrates, and
sodium. Thus far, the daily value of nutrient
34 2009 Taiwan Public Health Report
intake for 15 nutrients, including energy, protein,
carbohydrates, fat, sodium, calcium, iron, vitamins
B1, B2 and E, dietary fibers, vitamins A and
C, cholesterol, and saturated fat, have been
established.
Section 8 Health Education
To establish in the population healthy lifestyles,
the Department has promoted various health
education activities by means of mass media
such as TVs, radios, newspapers, magazines,
public transportation means, and the Internet
to systematically provide the public with correct
health information to help them build healthy
behavior, to self-manage their own health, and
to lay a sound foundation on good health and
happiness. Major achievements in 2008 are as
follows.
1. Integration of Health Education Resources
1) Health education themes are set; tuberculosis
control is integrated; resources of the National
Health Insurance are valued; correct use
of medical care resources is promoted; the
core values of the National Health Insurance
are supported; and a national hand-washing
campaign is promoted.
2) Health education resources are integrated and
health education channels are established.
Through diversified resources, continuing
promotion and integrated packing, the
knowledge of the public on health issues has
been improved. An identification system is
used to link policy and image. Channels are
also made available to respond immediately to
 the issues of concern of the public to remove
their doubts.
3) A Health 99 website is set up. Currently, there
are 1,324 kinds of educational materials on the
web for browsing, downloading or requesting.
4) For the easy reading of the public, the
Newsletter, Health Education Weekly, and
the e-Bulletin on Food of the Department, the
e-bulletin of the Bureau of National Health
Insurance, and the Food and Drug Safety
Weekly are integrated into one“Health
e-Bulletin”. At present, there are about 60
thousand subscribers.
2. Improving Knowledge of Health Education
Workers
A symposium on the exchange of innovative
ideas is held. Outstanding units are asked to
share their experiences in health education.
Experts and scholars are also invited to lecture
on new knowledge and innovations to improve
the skills and knowledge of the health education
workers in carrying out their duties.
A compilation of educational materials in 2008
is produced and distributed to 5,200 hospitals,
schools and other organizations for the use of the
front-line health education workers in their duties.
80% of the users are highly satisfied with the
contents, the editing and design of the publication.
3. Establishing a Cross-Ministerial
Cooperation Mechanism
Th e h e a l th p r o m o ti n g s c h o o l p r o j e c t i s
implemented in collaboration with the Ministry
of Education. School teachers and nurses are
trained and media are well coordinated to build a
resource platform for health promoting schools.
Hand-washing is promoted. Teachers and
caregivers of primary schools and kindergartens
are trained to be seed workers to promote correct
hand-washing in students and parents and thus to
practice healthy living.
Health Promotion 35
 37︱Section 1 Laws and Frameworks of
Communicable Communicable Disease
Control

4
Diseases 42︱Section 2 Control of Major

Control Communicable/Emerging
Communicable Diseases

46︱Section 3 Disease Control

Preparedness and Infection
Control

49︱Section 4 Immunization
 4 Communicable Diseases Control
In the control of communicable diseases,
in addition to the continuing efforts in epidemic
surveillance and investigation, preparedness for
disease prevention, research and immunization,
more should be done to expedite the amendment
of laws and regulations to comply with the world
trend, and to set up a disease control command
system. It is hoped that through a comprehensive
disease control system, epidemics can be early
detected and prevented to protect the health of all
the people.
Section 1 Laws and
Frameworks of
Communicable
Disease Control
To arrest the occurrence, infection and spread
of communicable diseases, the Communicable
Disease Control Act and other relevant laws
and regulations are specifically formulated to
adequately regulate the obligations and rights of
the people in communicable disease control, and
also for workers concerned to act in accordance
when executing their duties.
1. Laws and Regulations for Communicable
Disease Control
The Communicable Disease Control Act and
the HIV Infection Control and Patient Rights
Protection Act are the two important laws in the
prevention and control of communicable diseases.
To effectively realize these two important laws, 20
some relevant laws, regulations and orders were
amended or formulated in 2008, to bring in line
with the international trend.
1) Communicable Disease Control Act
The most recent amendment of the
Communicable Disease Control Act was made in
July 2007. Some major points of the amendment
are: (1) both the domestic and international
epidemic situations may serve as the factors
for the central competent authority to consider
activating the epidemics command center to
conform to the spirit of“disease control without
borders”; (2) quarantine framework is adjusted;
passengers, vessels, aircraft and cargos are
quarantined respectively; (3) to prepare for the
influenza pandemics, avoid the occurrence
and spread of zoonotic diseases, regulations
governing the management of vector animals
or animals known or suspected of transmitting
communicable diseases are made more specific
and comprehensive; regulations concerning
compensation and punishment are also added;
(4) the central competent authority shall
directly designate responsible hospitals in the
Communicable Disease Control Medical Network;
they will be subsidized at discretion; and (5)
legal basis for competent authorities to supervise
medical care institutions in enforcing infection
control is established.
Communicable Diseases Control 37
 2) HIV Infection Control and Patient Rights
Protection Act
To strengthen the protection of the rights of
the infected persons and to set up a coordination
mechanism for protecting their rights, the Act was
amended in July 2007; the original title of“the
AIDS Prevention and Control Act”was also
renamed to the“HIV Infection Control and Patient
Rights Protection Act”. Some major points of
amendment are: (1) in terms of the personal and
legal rights of the infected persons, it is clearly
stipulated that their basic human rights such as
nursing care and housing should be protected; (2)
regulations are added that the central competent
authority shall invite groups and private sectors
to promote the campaigns stipulated in the HIV
Infection Control and Patient Rights Protection Act;
(3) medical institutions shall not refuse to provide
medical care services to the infected; medical
personnel shall, upon consent of the person
concerned and through counseling process,
perform HIV tests; (4) legal basis is added for the
implementation of the harm-reduction program,
education of the high-risk groups, and mandatory
screening; it is clearly specified that persons
participating in the harm-reduction program who
were included in the Needle-Syringe Program
and Drug Substitution Treatment shall be waived
of criminal penalties; and (5) persons concerned,
if unfortunately infected with HIV in their course
of executing relevant duties, shall be reasonably
compensated to protect their rights.
2. Frameworks of Communicable Disease
Control
1) Frameworks of Communicable Disease
Control
Communicable diseases are controlled at two
38 2009 Taiwan Public Health Report
levels, the central and the local. The Centers
for Disease Control of the Department of Health
(Taiwan CDC) is the highest disease control
authority in Taiwan to be responsible for the
formulation of communicable disease control
strategies and plans, and also for the supervision,
direction and evaluation of local government
agencies. County/city health agencies formulate
their own action plans in accordance with the
strategies and plans of the central government,
and execute various communicable diseases
control programs accordingly.
2) Framework of Laboratory Testing
The Taiwan CDC is responsible for the
laboratory testing and research of various
communicable diseases in country. In 2008, the
Regulations Governing Laboratory Testing for
Communicable Diseases and Management of
Laboratory Testing Institutions, and the Operational
Guidelines on the Authorization of Laboratory
Testing Institutions for Communicable Diseases
by the Department of Health were announced to
promote an authorization system of institutions
in performing laboratory testing of notifiable
diseases. To assure the overall competency and
quality of laboratory testing, a quality monitoring
of laboratory testing is conducted. To meet the
demands for the laboratory testing of various
communicable diseases, 13 virus laboratories
and 9 tuberculosis bacilli laboratories have
been contracted. A National Plan for the Quality
Management of the Collection and Transportation
of Specimens of Communicable Diseases is also
formulated to assure the quality, timing and safety
of specimens sent by local health agencies for
laboratory testing.
3) Incident Command System
When the SARS epidemics devastated Taiwan
in 2003, for the lack of a disease-oriented disaster
control center as a focal point for coordination and
combat command between the central and the
local governments, the overall risk management of
the government in communicable disease control
was jeopardized. For this, the National Health
Command Center (NHCC) was established in
2005 to consolidate relevant information supplied
by ministries and departments concerned, local
governments and private sectors organizations,
and to transfer it into real-time information
needed for decision makers. Along with the
implementation of the International Health
Regulations 2005 (IHR 2005), a contact point for
liaison with other countries has been set up to
facilitate notification response of major epidemics
and public health emergencies.
3. Communicable Disease Control Medical
Network
To upgrade the response competency against
emerging communicable diseases, the Infectious
Disease Control Medical Network was set up in
2003. It was later renamed the Communicable
Disease Control Medical Network.
In 2008, the Regulations Governing Operation
of the Communicable Disease Control Medical
Network was announced. The country is divided
into six subnetworks; 141 isolation care and
emergency responding hospitals are designated
to accept and care for the infected. Supervision
and assessment of the operation of the negative
pressure isolation wards designated by 25
emergency responding hospitals are conducted
periodically to maintain the efficiency of the
negative pressure isolation wards. To assure that
the emergency responding hospitals can mobilize
their efforts to accept and care for patients during
disease outbreaks, they are asked to formulate
emergency responding plans of their own in
accordance with the H5N1 influenza strategic and
combat plan.
4. Disease Surveillance and Investigation
Mechanism
The number of cases of notifiable diseases in
the Taiwan Area in 2008 is shown in Table 4-1 and
Table 4-2. The surveillance and investigation of
epidemics situations are as follows.
1) Pluralistic Surveillance Systems for
Communicable Diseases
Sentinel surveillance networks are set up to
collect reports weekly and to evaluate the overall
trend in Taiwan. The information is feedback to the
sentinels.
(1) Sentinel surveillance system: By the end
of 2008, 799 physicians had volunteered
to become sentinels for the system which
covers around 87% of cities and towns
in Taiwan. Diseases monitored include
influenza-like illness, enterovirus infection
diarrhea etc.
(2) School-based surveillance system: By the
end of 2008, 611 primary schools had taken
part in this project, covering around 93%
of all townships throughout the country.
Diseases monitored include influenza-
like illness, hand-foot-mouth diseases or
herpangina, diarrhea and fever.
(3) Surveillance systems in densely populated
institutions: By the end of 2008, 1,732
institutions had participated in this project.
Diseases monitored include communicable
diseases of respiratory t systems and
gastrointestinal symptoms, and cluster
infections.
Communicable Diseases Control 39
 Table 4-1 Cases of Acute Notifiable Diseases, 2008

Category Disease Total Indigenous Imported

Smallpox 0 0 0
Plague 0 0 0
SARS 0 0 0
Ⅰ
Rabies 0 0 0
Anthrax 0 0 0
H5N1 Influenza 0 0 0
Diphtheria 0 0 0
Typhoid 33 13 20
Dengue Fever 714 488 226
Meningococcal Meningitis 19 19 0
Paratyphoid Fever 11 3 8
Poliomyelitis 0 0 0
Acute Flaccid Paralysis 74 74 0
Shigellosis 90 46 44
Amoebiasis 227 144 83
Malaria 18 0 18
Ⅱ
Measles 16 9 7
Acute Viral Hepatitis type A 236 201 35
Enterohemorrhagic E. coli Infection 0 0 0
Hemorrhagic Fever with Renal Syndrome 1 1 0
Hantavirus Pulmonary Syndrome 0 0 0
Cholera 1 1 0
Rubella 33 25 8
Chikungunya 9 0 9
West Nile Fever 0 0 0
Epidemic Typhus Fever 0 0 0
Pertussis 41 40 1
Tetanus 18 18 0
Japanese Encephalitis 17 17 0
Congenital Rubella Syndrome 1 0 1
Acute Viral Hepatitis type B 231 216 15
Acute Viral Hepatitis type C 124 122 2
Acute Viral Hepatitis type D 4 4 0
Ⅲ
Acute Viral Hepatitis type E 14 10 4
Acute Viral Hepatitis Unspecified 22 22 0
Mumps 1,145 1,145 0
Legionellosis 69 66 3
Haemophilus Influenza type b Infection 12 12 0
Neonatal Tetanus 0 0 0
Enteroviruses Infection with Severe Complications 373 373 0

40 2009 Taiwan Public Health Report

 Table 4-1 Cases of Acute Notifiable Diseases, 2008

Category Disease Total Indigenous Imported

Herpesvirus B Infection 0 0 0
Leptospirosis 47 47 0
Melioidosis 45 40 5
Botulism 11 11 0
Invasive Streptococcus Pneumoniae Infection 805 805 0
Q Fever 91 90 1
Endemic Typhus Fever 31 28 3
Ⅳ
Lyme Disease 2 0 2
Tularremia 0 0 0
Scrub Typhus 491 488 3
Varicella 3 3 0
Cat-Scratch Fever 28 28 0
Toxoplasmosis 2 2 0
Severe Complicated Influenza Case 22 22 0
Rift Valley Fever 0 0 0
Ebola-Marburg Hemorrhagic Fever 0 0 0
Ⅴ Yellow Fever 0 0 0
Ebola Hemorrhagic Fever 0 0 0
Lassa Fever 0 0 0
Notes:
1. Amended and announced by the Department of Health, the Executive Yuan, on October 24, 2008, under Shu-Shou-Chi
No. 0970001187, and became effective on November 1, 2008.
2. Data were re-downloaded on May 1, 2009 and the coverage period was from January 1, 2008 to December 31, 2008.
3. Data were analyzed by the onset dates.

Table 4-2 Confirmed Cases of Chronic and Other Notifiable Diseases, 2008

Category Diseases No. of Confirmed Cases

II MDR-TB 159
Smear- positive tuberculosis 5,559
Other tuberculosis 8,706

HIV infection 1,752

III
Hansen's disease 8
Syphilis 6,526
Gonorrhea 1,621
IV Creutzfeldt-Jakob disease 0
Notes:
1. Amended and announced by the Department of Health, the Executive Yuan, on October 24, 2008, under Shu-Shou-Chi
No. 0970001187, and became effective on November 1, 2008.
2. Data were re-downloaded on May 1, 2009 and the coverage period was from January 1, 2008 to December 31, 2008.
3. Data were analyzed by the diagnosis dates.
4. Tuberculosis confirmed cases were included in the statistics based on the dates of reporting.

Communicable Diseases Control 41

 2) Integration of Epidemic Reporting Systems malaria and poliomyelitis have been successfully
eradicated in recent years. However, along with
(1) Work is continued to integrate various
the increasingly frequent international interaction,
reporting systems and to enhance their
the threats of emerging and re-emerging
functions to achieve the goal of making
communicable diseases have increased day by
the entry of reporting into one, and thus
day, and the control of communicable diseases
to upgrade the efficiency of disease
has once again faced serious challenge.
notification.

(2) An integrated national disease control 1. Tuberculosis

information network was set up. The
The number of confirmed tuberculosis
network combines databases of the
cases in Taiwan has declined year by year. In
notification of communicable diseases
consideration of the current status of tuberculosis
and the geographic information system
and assessment of the effectiveness of control
(GIS), to collect communicable disease
efforts in the past as well as, and with reference
information through multiple channels to
to“The Global Plan to Stop TB (2006-2015)”of
timely monitor and control epidemics.
the WHO, the Department has formulated
(3) Investigation of Epidemics a Mobilization Plan for halving Tuberculosis
incidence in Ten Years, with a view to reduce
The communicable disease epidemics
incidence of tuberculosis to 34 per 100,000 by the
investigation information system is constructed to
year 2015. International cooperation is actively
assist in the epidemic investigation of notifiable
promoted; academic research is developed; and
diseases, and to produce a model questionnaire
private sectors as well as government sections are
to help medical staff analyze of the epidemic
encouraged to join fighting against tuberculosis.
situations or for the reference in preparing
Achievements in 2008 are as follows.
management measures.
1) The Directly Observed Treatment Short-
The Field Epidemiology Training Program
Course (DOTS) has been promoted. By the
(FETP) is continued to prepare manpower in field
strategy of“delivering medicine to hand,
epidemiology and to timely control outbreaks.
supervising medication on the spot, and
The result of investigation is supplied to the
leaving after medicines are taken”, the failure
administration for reference.
rate of treatment and relapses are effectively
reduced, and cases of multiple drug-resistant

Section 2 Control of Major tuberculosis are prevented. Currently, about

90% of all sputum positive cases are included
Communicable/
in the plan.
Emerging
2) T h e M u l t i p l e D r u g - R e s i s t a n t ( M D R )
Communicable
Tuberculosis Medical Care System began to
Diseases operate on May 1, 2007. Through collective
Diseases such as plague, smallpox, rabies, management and care and by the expanded

42 2009 Taiwan Public Health Report

 DOTS plan (DOTS-Plus), the success rate
of treatment of MDR-TB cases has been
improved.
3) A set of Exit Control of Tuberculosis Patients
by Air Travel was announced on September
1, 2007 to interrupt the spread of tuberculosis
and to improve the international image of the
country.
4) Since April 1, 2008, a plan for the treatment
of latent tuberculosis has been practiced.
In coordination with the Direct Observation
Preventive Treatment (DOPT) plan, the
incidence of tuberculosis is expected to be
reduced. In 2008, 1,490 cases took part in this
project.
5) Case finding is actively promoted. Mobile
X-ray vans go around the country for chest
X-ray examination, for 176,247 person-times.
Epidemics situations in 2008 had declined; and
the number of confirmed cases dropped by 2%
over 2007.
2. Communicable Diseases of the Enteric
Tract
1) Enterovirus
The epidemic situations of enterovirus
infection are closely monitored through the
Notifiable Disease Surveillance system, the
Sentinel Surveillance system, and the Laboratory
Surveillance systems for virus infections.
Preventive strategies in 2008 include, (1)
county/city health bureaus are commissioned
to implement the intensified control plan for
enterovirus infections in communities; local seed
workers are trained; community health education
is strengthened; (2) training on the clinical
treatment of serious complications of enterovirus
infection is conducted; the timing for the referral
of suspected serious cases and matters to be
noticed at time of treatment are emphasized to
upgrade the professional knowledge and skills of
medical and nursing personnel; and (3) hospitals
are designated to treat the serious cases of
enterovirus with adequate medical care, and to
reduce the fatality rate and the occurrence of
sequelae.
2) Hepatitis A
The incidence of hepatitis A in mountain
townships had dropped from 90.7 (183 confirmed
cases) per 100,000 in 1985 to 0 in 2008. In
2008, The Taiwan CDC has implemented a pilot
project called the“Hepatitis A prevention and
immunization plan targeting night market food
venders.” The plan screens vendors; those who
haven't had immunity are given vaccination; and
those who have immunity or have been immunized
are issued certificates, for the reference of the
public in choosing food stands for consumption.
3. Dengue Fever
Strategies of prevention and control in 2008
are: (1) a mobilization mechanism has been
set up; coordination meetings of health and
environmental protection authorities have been
held; a joint inspection model is established;
county/city governments are requested to set up
dengue fever command centers at county/city
and township/district levels; (2) health education
of the public is intensified; work manuals for
the prevention and control of dengue fever are
amended; training of disease control workers and
medical/nursing personnel is strengthened to
include vector mosquito survey and emergency
spraying; (3) surveillance mechanisms for
breeding sources, larva and vector mosquitoes
Communicable Diseases Control 43
 have been established and strengthened; syringes, 418 needle vending machines
surveillance of virus mosquitoes and studies on were offering clean needles and syringes
the drug-resistance of vectors mosquitoes are free of charge; the recalling rate of used
conducted. needles and syringes was 61%.

(3) The Five-Year Phase IV program of the

4. Blood and Body Fluid-Transmitted
AIDS is implemented. There are 36
Communicable Diseases
hospitals designated for the care of AIDS
1) AIDS throughout the country, and five hospitals

(1) By the end of 2008, there had been a are designated to provide free medical care

cumulative total of 17,428 cases of HIV to drug addicts infected with AIDS. Free

infection (including 680 foreigners). Of the anonymous HIV screening is conducted to

indigenous cases, 5,183 had developed enhance the screening of high-risk groups

into full-blown AIDS; and among them, and specific groups. In 2008, a total of

2,199 had died. The number of new cases 11,194 persons had been screened, and

had dropped since 2005, and for the last the positive rate was 2.15%.

three consecutive years. (4) To prevent the vertical transmission of

(2) To face the increase of AIDS infection in HIV from mothers to children, all pregnant

drug addicts, the harm-reduction program women are screened against HIV. By

of AIDS for drug addicts was launched in 2008, 72 pregnant women had been

2005. Major strategies include, (1) HIV detected HIV positive (including 16 aliens).

screening for drug addicts is expanded 2) Sexually Transmitted Diseases (STD)

to early detect cases for timely treatment;
Work is continued in the health education of
(2) a Needle-Syringe Program (NSP) is
the public on the control of sexually transmitted
conducted to provide drug addicts with
diseases, and in providing laboratory testing
supervision and follow-up, and drug-
services of HIV for patients of sexually
cessation counseling, to prevent them from
transmitted diseases. In collaboration with private
being infected with hepatitis B, hepatitis
institutions, sex disease-friendly clinics are set
C and AIDS; (3) a substitution treatment
up. Supervision and treatment of contacts are
is offered to IDUs with oral substitutes
strengthened for more effective prevention. The
of lower hazards in place of intravenous
sentinel physician reporting and surveillance
injection of high danger; they are followed-
of sexually transmitted diseases was initiated
up and supervised, given health education,
in 1993. In 2008, there were 283 medical care
and referred to drug-cessation; by the
institutions along with 684 n doctors joined this
end of 2008, 87 medical institutions
project. The notification of STD and transfer of
throughout the country were providing
HIV specimens are thus realized.
drug substitution treatment services, and
3) Hepatitis B and C
1,103 stations were offering counseling
and health education on clean needles and A pilot project, Enforce Hepatitis B and C Trial

44 2009 Taiwan Public Health Report

Treatment Program, began in 2003, hoping to
significantly reduce incidences of liver cirrhosis
and liver cancer. Work is continued to conduct
screening of pregnant women at prenatal care for
hepatitis B, and immunization of the newborns
against hepatitis B. The carrier rate of children at
age six has declined from 10.5% in 1989 before
the immunization program to only 0.8% in 2007.
Make-up immunization against hepatitis B of pre-
school age children and school children upon
enrollment in school is also conducted.
5. Prevention and Control of Emerging
Communicable Diseases
1) 2008 Symposium on Zoonotic Diseases and
Training Activities
Issues of the Symposium include the zoonotic
diseases newly added to the list of notifiable
diseases as well as, and major outbreaks
and special cases of these diseases either
domestically or internationally, to intensify
knowledge of zoonosis and their preventive
measures. The Manual for Creutzfeldt-Jakob
D i s e a s e a n d o t h e r H u m a n Tr a n s m i s s i b l e
Spongiform Encephalophathies - Guideline on
Patient Management and Infection Control is
amended. Training programs on the reporting and
infection control of Creutzfeldt-Jakob disease are
organized for members of dental associations and
long-term care institutions.
2) Surveillance Systems for Emerging and Re-
emerging Communicable Diseases
Work is continued to build a national
background database on the host animals of
emerging communicable diseases common to
men and animals. Academic institutions were
commissioned to conduct surveys of the Norovirus
on pig farms in 2008. The surveys indicated that
the risk factors associated with the Norovirus on
pig farms were, farms in the southern part of the
Island, white-hair pigs, pigs for meat, and during
autumn and winter seasons. All viruses are of the
second genotype in two subtypes, including the
fourth subtype, which is at present considered the
subtype that is primarily responsible for the global
prevalence of enterogastritis in winter. There is
also the second subtype that is genetically similar
to the Japanese virus strain.
6. Prevention and Control of Imported
Communicable Diseases
1) Quarantine
Necessary quarantine measures are taken
against vessels, aircraft, crew and passengers.
To maintain the sanitation and security of ports of
entry and exit, a sanitation of ports and security
team is organized jointly by the Taiwan CDC and
the concerned authorities to prevent the entry
or export of communicable diseases. Cases
without fear of public health hazards are allowed
to proceed with their international journey. By
regulations of the IHR (2005), they are reported to
the competent authorities of the next port of entry.
2) Communicable Disease Control in Travel
To e a r l y d e t e c t a n d e ff e c t i v e l y c o n t r o l
communicable diseases, infrared thermal
apparatus are installed at international ports to
scan the body temperature of inbound passengers.
Inbound passengers suspected of communicable
diseases are required to fill in the“Communicable
Disease Control Survey Form”for assessment
and follow-up management. Light-boxes, posters
and bulletin boards are set up for public education;
educational materials such as leaflets and videos
are produced to improve the knowledge of the
public on the prevention of communicable diseases
Communicable Diseases Control 45
 in traveling and to improve their self-management
of health.
3) Health Management of Alien Laborers
(1) To prevent the import of communicable
diseases, all legally imported alien laborers
are required of health examinations for
application of entry visas. They are, after
entry into the country, further required to
undergo health examination at designated
hospitals 30 days before or after being
employed for 6 months, 18 months and
30 months. Alien laborers failing in any
one item of the examinations after entry,
with the exceptions of intestinal parasites
(except Entamoeba histolytica), that
are given 45 days for treatment and re-
examination; and and syphilis that is given
30 days to complete the treatment.
(2) In 2008, 373,105 person-times of alien
laborers had gone through regular
health examinations (not including the
examination three days after entry), and
the failure rate was 8.54%. The failure
rate of intestinal parasites was the highest
at 8.36%; that of pulmonary tuberculosis
came next, at 0.16%. The HIV antibody
positive rate was 0.01%.
Section 3 Disease Control
Preparedness and
Infection Control
Measures taken to upgrade the overall national
capacity to face disease outbreaks and biological
agents disasters are as follows.
1. Influenza Pandemics
To tackle with the influenza pandemics, the
46 2009 Taiwan Public Health Report
Department has formulated four strategies, Early
Detection, Interruption of Transmission, Antiviral
Medicines, and Influenza Vaccines, and five
defense lines, containment abroad, border control,
community epidemic control, normal function
of medical system, and individual and family
protection. Achievements in 2008 are as follows.
1) Strategies and combat plans are renewed. In
coordination with the WHO and information
around the world, the Influenza Pandemic
Strategic Plan is renewed; and the action plans
and the Strategy Plan for the Execution of
Influenza Pandemic Response are amended.
2) Different antiviral drugs are stockpiled at the
level of 10% of the population; and the priority
list of drug use is established. Work plans for
antiviral drugs against influenza are formulated
to be part of the SOP for disease control. A
process to activate the use of the raw materials
of Tamiflu is completed. Drills without advance
warning are held for drug dispensing firms.
3) Plan for the stockpile and the use of H5N1
vaccine is completed. H5N1 vaccines are
stockpiled as short-term supplies for combat
readiness. According to the priorities of
immunization for high-risk groups of exposure
to influenza, voluntary immunization of core
risk-groups were completed in April, 2008.
4) Knowledge and skills of workers at various
levels and the general public have been
upgraded. Eight digital learning curricula on
influenza pandemics have been organized;
and focusing on different groups, 13 kinds of
educational materials have been produced.
5) International cooperation is actively promoted.
The Taiwan CDC participated in the APEC
international visual conferences, and the
 Cross-National Collaborative Study Plan on
Influenza of the European Union. Delegation
was sent to the 13th International Conference
o n In fe c ti o u s D i s e a s e s ( IC ID ) to s h a r e
results of the preparedness of Taiwan against
influenza pandemics.
2. Counter Bio-Terrorism
Work is continued to review the counter bio-
terrorist attacks response mechanism, and
to renew the organization of the bio-defense
response teams. In addition, in 2008, stocks of
medicines and defense facilities were reorganized.
15,000 doses of antibiotics against Anthrax are
renewed; updated biological and chemical defense
facilities, specimen collection devices and kits are
purchased, to maintain the capacity in confronting
bio-terrorist incidents.
3. Management of Disease Control Supplies
To meet the demands for epidemic control and
possible biological agents disasters, personal
protection equipment (PPE) is managed by
integrating information concerning the supply
end, the flow process as well as the demand
end. Several contracts on supply are signed;
and a mechanism for the dispatch of N95 surgical
masks and protection clothing is set up. In the
safety stocking and management, a management
information system (MIS) for supplies has been
established; and supplies are stocked in sufficient
amount at three levels of the central government,
local governments and hospitals in separate
warehouses to share risks and shorten time
required for delivering.
To a s s u r e t h e s m o o t h o p e r a t i o n o f t h e
emergency dispatching of supplies, drills on the
delivery of supplies are held. A set of standard
operational procedures on the flow of supplies
and their management has been formulated. The
Regulations Governing the Operation Procedures
and Compensations for the Expropriation
and Requistion of Property for the Control of
Communicable Diseases, and another set of
Regulations Governing Implementation of the
MIS are amended to facilitate the management of
disease control supplies.
4. Nosocomial Infection Control
To protect the safety of patients and to
effectively realize nosocomial infection control,
several policies have been formulated. In January
2008, a set of Regulations Governing Inspection of
the Implementation of Infection Control Measures
in Medical Care Insitutions was announced for
implementation. Major achievements are as
follows.
1) To upgrade the quality of inspection on
infection control in hospitals, the Taiwan
Joint Commission on Hospital Accreditation
was commissioned to conduct on the spot
inspection of infection control in 495 hospitals.
2) To effectively monitor nosocomial infection in
hospitals, the Taiwan Nosocomial Infection
Reporting System was used for the voluntary
reporting by hospitals. Around 300 hospitals
are in use of this system. In 2008, the Taiwan
Joint Commission on Hospital Accreditation
was commissioned to implement a plan for
the consistent assessment of the promotion
of the new definitions of nosocomial infection;
relevant practical case-study workshops were
organized.
3) Professor Didier Pittet, an international expert
on nosocomial infection control and hand
hygiene, was invited to lecture on the WHO
Communicable Diseases Control 47
 directions in hand hygiene and control of
antibiotics.
5. Research and Laboratory Testing
1) Plans for the establishment of reference
laboratories for six major pathogenic agents
of communicable diseases, yellow virus,
mycobacterium bacteria, fungi, virus and
parasites, have been completed to greatly
upgrade the skills and capacities of laboratory
testing. The first domestically produced
volume of the electro-microscopic atlas of
clinical microbes is also completed. The
Atlas illustrates the taxonomy morphological
specifics, history, and the epidemic situations
of the diseases in Taiwan for 13 viruses, 24
bacteria, and two strains of fungi.
2) A plan to develop a platform for the surveillance
skills of unknown/emerging pathogenic agents
is ongoing to strengthen the collection of
specimens of unknown/emerging pathogenic
agents. Multiple molecular testing methods
have been actively brought in and developed
to improve the laboratory diagnostics skills of
emerging infectious diseases.
3) In 2006, a“PulseNet Taiwan”was set up to
provide quick confirmation and matching for
cluster food-borne communicable diseases to
effectively control the spread of diseases. The
PulseNet Taiwan also serves as a platform
for exchanging information with international
surveillance systems and academic institutions.
The National Influenza Center (NIC) has been
set up to integrate domestic and international
surveillance, to track down and report trends of
change of influenza viruses, and to serve as a
platform for exchanges with other NICs across
the world.
48 2009 Taiwan Public Health Report
4) In collaboration with the National Institute of
Infectious Diseases (NIID) of Japan, projects to
construct a molecular epidemiology laboratory
network for diseases prevalent in Asia such
as dengue fever and other vector-borne
diseases, and development of technology on
multilocus variable number tandem repeat
analysis (MLVA) of intestinal bacteria are
under progress. A collaborative relationship
has been built with the Aberdeen University of
the UK and the Chiba University of Japan to
exchange information on bacteria strains types.
In collaboration with the National Institute of
Public Health and Environmental Protection
of the Netherlands, a global surveillance
project on the Beijing strain of tuberculosis is
undergoing. The Taiwan CDC also participated
in the WHO and US CDC-sponsored global
rotavirus vaccine plan, and is a member of the
Asian Rotavirus Surveillance Network (ARSN).
5) Pathogenic gene database: Work is continued
to integrate and renew the sequencing
typing automation procedures and laboratory
information management systems. The entire
process of gene sequencing from collection,
PCR, matching and result analysis is integrated
in one, and the functions of the follow-up of
specimens, data matching, and automatic
delivery of mails, and renewal of the front-end
gene databases have been improved.
6. Bio-Safety of Laboratories
Since 2006, a set of“Regulations Governing
Management of Infectious Biological Materials
and Collection of Specimens from Patients of
Communicable Diseases”has been implemented
to provide a legal basis for the management of
infectious biological materials and laboratory bio-
safety. By the core principles of self-management,
correct reporting, and key-point inspection, a legal
basis for the management of infectious biological
materials and bio-safety of laboratories is
provided. By the end of 2008, 426 units had been
authorized to set up bio-safety committees (or
full-time responsible personnel) to complete the
functions of the bio-safety organization, building
a high-quality bio-safety environment which meet
the international standard.
Section 4 Immunization
Development of vaccines and immunization
can effectively prevent and control diseases that
are vaccine-preventable.
1. Current Status of Immunization and Trend
The ten routine immunizations currently
provided are BCG, hepatitis B, DPT (diphtheria,
pertussis and tetanus combined), oral polio
vaccine, chickenpox, MMR (measles, mumps
and rubella combined), Japanese encephalitis,
influenza, Td (tetanus and reduced diphtheria
toxoid), and hepatitis A (in mountain townships
and high-risk areas). An application and review
system for the relief of victims of immunization
was set up by the government to offer adequate
relief.
To provide convenient immunization service
and improve coverage rate, counties and cities
have actively requested hospitals to assist in
immunization; and more efforts are rendered
in areas of lower coverage rates to encourage
immunization and make-up immunization through
follow-up. The immunization coverage rates of
children in 2008 are shown in Figure 4-1.
On October 1, 2008, a project began to
immunize the elderly 75 years and above against
Streptococcus pneumoniae, in conjunction with
immunization against influenza at the same time,
to reduce the occurrence of severe complications
and deaths, to lower medical costs as well as
improve the health and welfare of the elderly.
2. Development and Manufacturing of Serum
Vaccines
1) Production of Biological Products
(1) A total of 1,808,005 doses of vaccines,
toxoid, antitoxin and antivenin serum have
been supplied periodically. Three batches
of test fluid, 4 batches of final products
and 12 batches of raw serum materials
of antivenin serum products have been
produced. 12 batches of semi-products of
BCG and 5 batches of BCG final products
have been tested. One batch of diphtheria-
tetanus products, 4 batches of tetanus
toxoid products, 130 batches of pure water
testing and 11 batches of raw materials
have been tested.
(2) Animals for experiment such as mice,
guinea pigs, rabbits, poisonous snakes
and ferrets are supplied and raised on
contract. Antivenin serum is manufactured
by using horse serum. A total of 293 liters
of antivenin horse serum were produced in
2008.
2) Development of Bio-Products
(1) Influenza Research and development
project on influenza
Achievements in 2008 are as follows. (1)
Based on the HA gene sequences of H5N1 virus,
DNA vaccines are designed; the manufacturing
skills of the DNA vaccines for novel influenza are
Communicable Diseases Control 49
 Figure 4-1 Immunization Coverage Rates for Young Children, 2008

％
100 Basic dose Booster dose

98.08
98
96.85
96.51
95.97 96.14
96
94.92

94
93.09
92.77
HBV2 HBV3 MMR1
92
OPV3 OPV4 DTP3 DTP4 91.11

JE2 JE3
90

88
HBV OPV DTP MMR JE Vaccines

Note: HBV2, HBV3, OPV3 are for cohorts born between January 1 and December 31, 2007; DPT4, OPV4, MMR1, JE2 are
for cohorts born between January 1 and December 31, 2006; and JE3 is for cohorts born between January 1 and
December 31, 2005.
Source: National Immunization Information Management System (data downloaded in January 2009).

established; and sufficient DNA vaccines can
be manufactured within six months to meet the
demands of epidemic outbreaks. (2) Research
teams for the clinical trials of influenza vaccine
immunization were set up to analyze the protective
titers of the indigenous virus strains and vaccine
strains of those immunized against influenza.
(3) The clinical testing laws and regulations
for a consultation and assistance mechanism
of the“Taiwanese Vaccine R&D (including
Mass Production Technology) Project”were
established, and the preclinical CMC review check
list needed for early clinical testing was completed.
(2) Development of enterovirus type 71 particle
vaccines
Achievements in 2008 are as follows. (1) The
enzyme linked immune absorption experiment
method has been successfully improved to detect
the virus-like particle (VLP) protein. (2) The VLP
manufacturing processes are established to purify
high concentration (≒ 900 µg/ml) VLP samples
in one liter of cell fluid. (3) Thus far, 15.3 mg of
purified VLP (≒1.528 mg/ml, 10 ml) have been
produced, and experiment on monkeys is ongoing.
3) Domestic Vaccines Research System
For effectively promoting the commercialization
of the results of research and development,
the Taiwan CDC has signed contracts with the
National Health Research Institutes (NHRI) on
two items of technical transfer. They are, the
authorization of NHRI on the technical transfer of
the manufacturing techniques of enterovirus type
71 by cell culturing method, and the technical
transfer of the manufacturing techniques of
Japanese encephalitis vaccine by cell culturing
method.

50 2009 Taiwan Public Health Report

 Management 52︱Section 1 Safety Management

of Food and
5
of Food and Drugs

58︱Section 2 Management of
Drugs Controlled Drugs

60︱Section 3 Laboratory Testing

for Food, Drugs and
Cosmetics
 5 Management of Food and Drugs
Being a member of the WTO (World Trade
Organization) and APEC (Asia Pacific Economic
Cooperation), and along with the increasing
volumes of international trade in food and drugs,
to meet the impact of the opening of markets,
issues such as the safety management of food
2) Safety Management of Chinese Medicines
and drugs, education of the public on safe use
of drugs, control of drug abuse, establishment
of international mutual recognition, and the
upgrading of the quality of domestic products have
become most important in Taiwan.
Section 1 Safety Management
of Food and Drugs
The quality of food and drugs, the flow
of products, and the services provided by
professional workers are closely associated with
the health of the people. Therefore, in addition to
establishing a strict management mechanism for
food and drugs, promoting good manufacturing
practices, and establishing international mutual
recognition, more is done to strengthen education
of the public to transmit correct information, and
thus to assure the health of the people.
1. Safety Management of Drugs
The following activities have been actively
promoted to protect the health of the people.
1) A 2008 National Symposium on Pharmaceutical
Affairs was held on September 10-12, 2008,
52 2009 Taiwan Public Health Report
focusing on“constructing an environment
of safe drug use”. Health bureaus shared
their experience; and major issues in
pharmaceutical affairs and important public
policies were announced at the same time.
(1) GMP is universally practiced by all Chinese
pharmaceutical factories. By December
2 0 0 8 , 11 8 C h i n e s e p h a r m a c e u t i c a l
factories were practicing GMP.
(2) To realize the labeling on the packing of
Chinese medicine materials, on October
14, 2008, a set of principles on items to be
labeled on the tag or packing of all imported
and marketed Chinese medicine materials
and decocting pieces was amended and
announced. 143 more items of imported
and marketed Chinese medicine materials
and decocting pieces are required of
labeling on the tag or packing, totaling 324
items.
(3) On February 5, 2008, the Standards for the
Clinical Trial of New Chinese Medicines
were announced.
(4) For the safe use of consumers, and to
upgrade the quality of extract products,
on September 12, 2008, Article 86 of the
Principles Governing Registration and
Market Approval of Pharmaceuticals was
amended and announced. Regulations
 governing the total amount of heavy metals
in extracts of Chinese medicines, the total
amount of heavy metals and arsenic in 10
preparations of extract Chinese medicines,
and the total amount of microbes in 10
preparations of extract Chinese medicines
were announced for the industries to
comply with.
(5) O n N o v e m b e r 2 5 , 2 0 0 8 , n i n e m o r e
Chinese medicinal materials were added
under the items of“edible Chinese
medicinal materials”. By the end of 2008,
212 Chinese medicinal materials had been
so announced.
3) Control of Illegal Drugs and Advertisements
(1) A special project, the 2008 joint inspection
of illegal pharmaceuticals, cosmetics and
food, was carried out, focusing inspection
of markets, vending stands, night markets,
Chinese boxing clinics, alternative therapy
clinics, chiropractics, Chinese medicine
hospitals and clinics, pharmacies, and
Chinese medicine pharmacies, to inspect
whether counterfeit and prohibited drugs
were sold, whether the firms carried a
practice license, the labeling of medicines,
and the illegal practice of un-licensed
personnel. In total, 222 sites had been
inspected to find 69 violations.
(2) In 2008, 2,334 cases of illegal drugs
had been seized, including 242 cases of
counterfeit drugs, 13 cases of prohibited
drugs, 26 cases of misbranded drugs,
141 pharmaceutical dealers in violation
of regulations, 246 labeling and testing
specifications not in line with regulations,
1,609 advertisements in violation of
regulations, and 57 other cases.
(3) In 2008, a project, monitoring of illegal
advertisements on newspapers and
magazines, was carried out. The results
are shown in Table 5-1. 3,134 cases were
suspected of law-breaking. They were
reviewed by the Department, and then,
referred to local health bureaus for action.
In total, 1,327 cases were confirmed of
law-breaking, and the fines amounted to
NT$ 271,850,000.
4) To provide the public with relief to drug
hazards, in October 1998, a set of Guideline on
Drug Hazards Relief was announced; effective
January 1999. To make the relief system more
comprehensive, in May 2000, the Drug Relief
Act was promulgated. In 2006, the review
criteria were relaxed and payments were
raised. By the end of 2008, 994 applications
had been received; of them, 415 cases were
accepted and compensated, at a compensation
rate of 46.68%. The total amount of relief was
NT$ 155,250,000.
2. Good Manufacturing of Pharmaceuticals
and International Mutual Recognition
To strengthen the drug review system, to
upgrade the quality of domestic pharmaceutical
products, to link them with the international
community, and thus to improve their international
competitiveness, action has been taken to actively
promote good manufacturing practices (GMP)
of pharmaceuticals and international mutual
recognition.
1) Work is continued to promote the GMP of
pharmaceuticals. By the end of 2008, 161
domestic pharmaceutical factories were
practicing GMP, and 139 factories were
practicing cGMP. At present, 771 drug
Management of Food and Drugs 53
 Table 5-1 Illegal Advertisements on Newspapers and Magazines, 2008

No. Closed not Closed No. of

Amount of Fines
Nature Violations
No. of Cases No. of Cases No. of Cases (NT$)
Confirmed
Chinese
100 100 0 91 1,540,000
pharmacy

Western
185 183 2 71 2,540,000
pharmacy

Chinese
78 78 0 47 536,000
medicine

Western
195 195 0 106 3,740,000
medicine

Foods 1,029 839 190 558 13,770,000

Cosmetics 1,324 1,275 49 654 8,704,000

Medical
68 51 17 21 1,890,000
devices

Unknown 1 1 0 0 0

Beauty and
62 59 3 9 170,000
weight-control

Others 92 67 25 24 1,010,000

Total 3,134 2,848 286 1,581 33,900,000

Note: “Violations confirmed”refers to cases that have actually been processed by the administration.

importing factories have applied for the third
phase validation review; of them, 652 factories
have passed the review. In addition, 123
drug importing factories have applied for on-
spot inspection; of them, 102 have passed the
review.
a letter of exchange on technical collaboration
in medical devices has been signed with
the Swissmedic, the Swiss Agency for
Therapeutic Products, to facilitate international
harmonization and mutual recognition in the
management of medical devices.

2) Accreditation of GMP for medical devices

is continued. 460 factories of domestically
manufactured medical devices have been
registered for GMP; and 3,079 factories have
been registered for QSD (Quality System
Document) of imported medical devices.
3) By the exchange of letter on medical devices
signed between Taiwan and the EU, technical
collaboration plans have been signed with 12
EU medical device notified bodies. Thus far,
3. Safety Management of Food
To remove the fear of people from buying
harmful food and to assure their health, regulations
for imported food are strengthened; information
of unqualified food items is announced; and a
food consumption warning system, the Food
Safety Signals, and a food traceability system are
established.
1) Food safety related regulations are reviewed

54 2009 Taiwan Public Health Report

 and amended. To strengthen the current
management of food sanitation, and following
the international regulations, food industries
are asked to practice more self-management
and to place more responsibility on their
products. In 2008, the Food Sanitation Act was
partially amended, and the amendment was
promulgated on June 11.
2) Management of imported food is strengthened.
In accordance with the Regulations Governing
Inspection of Imported Food, persons
responsible for customs declaration, place
or country of origin, if repeatedly importing
products not meeting requirements, may
ask the relevant dealers or government
organizations of the exporting country to
present plans for improvement. Live, fresh
and frozen fishery products that are found not
meeting regulations, their dealers are asked to
immediately recall the products from shelves,
and their inspection frequency is adjusted
upward to 20%. In 2008, as a result of the
melamine contamination of dairy products in
mainland China, importation from China of all
dairy products was temporarily suspended;
and the China government was asked to come
up with improvement plans. Melamine is now
made a key item for the inspection of imported
food.
3) R e p o rti n g syste m i s stre n g th e n e d , a n d
information is released immediately. Under
the principle of transparency, information is
made public soon after reports of unqualified
inspection of imported food come in. The
information is posted on the“unqualified
food information”of the food website of the
Department. In 2008, 117 items of unqualified
imported food were announced.
4) A food safety signal mechanism is set up.
When food safety is in suspicion, professional
scientific basis and risk assessment are used
as a communication platform to decide the
results in the form of red-yellow-green safety
signal system (Table 5-2). Red light stands
for hazardous; yellow light is for safety under
suspicion; and green light indicates low
hazards to human health. This mechanism
also applies to international food safety.
When major incidents of international food
safety are reported, they are either placed on
newspapers or are indicated by the food safety
signal mechanism. In 2008, 10 international
food safety incidents were indicated by this
mechanism.
5) A risk management for food contaminants
is established. Ministries and departments
concerned meet periodically to integrate
r e s o u r c e s a n d p r o c e s s m a t t e r s t i m e l y.
Focusing on the management of environmental
pollution and food safety at the sources of
production, a set of Management Procedures
for the Reporting and Response of Incidents of
Environmental Protection and Food Safety has
been formulated. A food inspector system has
also been set up.
6) The management of harmful food is practiced.
Classification and inspection are strengthened.
A hotline is set up for consumers to report. A
special project of cross-county/city inspection
of food safety is promoted. Education of the
public is intensified to help them identify safe
food. The Food Sanitation Management Act is
amended.
7) Promotion of HACCP (Hazard Analysis Critical
Control Point)
(1) I n 2 0 0 6 , t h e H A C C P s y s t e m w a s
universally practiced on all fishery products.
Management of Food and Drugs 55
 Table 5-2 Food Safety Lights

Light Denotation

a. Hazardous to human health or not, should not be used for human consumption
b. Immediate hazards to human
c. Validity date exceeded
Red
d. Not safe and may be hazardous to human health
e. In violation of the permissible amount standards for food safety and also hazardous to human
health
f. Food adulterated with drugs
g. Assessment of health risks indicates high possibility of hazardous to human health

a. No immediate hazards to human health; hazards are suspected, and in-depth investigations
Yellow or improvement are needed
b. Food suspected of not safe
c. In violation of the permissible amount standards for food safety, though not hazardous to
human health, however the impact is large
d. Assessment of health risk indicates suspicions of hazardous to human health

Green a. Incomplete labeling

b. Though may be hazardous, risk factors have been controlled
c. All rumors; products are safe
d. Assessment of health risk indicates very low possibility of hazardous to human health

Databases on facts of fishery products completed for fresh milk, flavored milk, yogurt,
found not meeting requirements and the and non-alcoholic beverage (including bottled
current status of industries practicing water, coffee and tea) industries. A processed
HACCP have been established. food traceability network is completed for 15

(2) On August 15, 2007, it was announced items of fresh milk on market, one item of

that meat processing industries shall yogurt, 11 items of bottled water, and five items

comply with regulations of HACCP; and of coffee and tea.

this practice would be implemented step by
step a year after the announcement.
(3) On September 12, 2007, announcement
was made that all boxed lunch factories
shall comply with regulations of HACCP.
The practice would be implemented step
by step. Since September 15, 2008, all
boxed lunch industries that supply more
than 3,000 pieces of boxed lunch a day
shall comply with regulations of HACCP.
8) In 2008, the food traceability framework was
9) To improve the professional knowledge of
food-delivery industries, and to assure the
safety and quality of food in the entire process
from production, manufacturing, transportation,
sales, and delivery to the hands of consumers,
the Department has posted the background
information of domestic food-delivery industries
and those that have undergone training on
the website of the Taiwan CAS Development
Association for the inquiries of health agencies,
dealers and consumers.

56 2009 Taiwan Public Health Report

10) A management system for the voluntary and 4. Safety Surveillance Mechanism for Food
mandatory labeling of genetically modified and Drugs
ingredients in food is implemented. Thus far,
To safeguard the safety of drug use and buying
17 cases of genetically modified soybeans
and consumption of food, the Department has
and corns and five cases of mixed genetically
made all efforts in the inspection and seizure of
modified corns have been reviewed and
illegal food and drugs, set up mail-box and toll-free
approved.
telephone lines for reporting to arrest the rampage
11) A food poisoning surveillance mechanism is and hazards of illegal food and drugs.
set up. In 2008, there were 269 incidents
1) The safety surveillance system for drugs
of food poisoning, affecting 2,961 persons,
is continued. In September 2004, the
with 0 deaths. When compared with the
Regulations Governing Management of Drug
240 incidents and 3,223 victims of 2007, the
Safety Surveillance was announced, and
number of incidents had increased by 29,
drug safety surveillance period was adjusted
and the number of victims had decreased by
from seven years to five years. Some
302 persons. Of the food poisoning incidents
designated medical devices were placed
in 2008, by place of food intake, more
under surveillance for a period of three years.
occurred at places where food was supplied
Currently, 1,105 items of drugs and 17 items
(125 cases), schools (48 cases), home (37
of medical devices are placed under safety
cases), and offices (22 cases). They were
surveillance. They are posted on the website
similar to those of 2007.
of the National Drug Adverse Reactions
12) The sanitary management of public eating Reporting Center.
places is strengthened. By the end of 2008,
2) To timely detect adverse reactions of new
27,637 cooks had been licensed, and the
drugs under clinical trial, the National Drug
goal was attained by more than 100% (the
Adverse Reactions Reporting Center was
goal was 25,000 cooks).
set up. By the end of 2008, 31,708 cases of
13) Management of special dietary food is adverse reactions of drugs after marketing, and
promoted. Special dietary food refers 38,412 cases of adverse reactions of drugs
to“infant formulas and supplementary under clinical trial had been reported.
food for older infants”, and for adult use
3) Registration and market approval of food is
that have been adjusted for their nutrient
implemented to assure the safe use of food of
components, including adjusted protein,
the public.
amino acid, fat or minerals-adjusted food and
low-allergic, body-weight control food, and (1) By regulations of Article 14 of the Food
food for tube-feeding. Food that is within the Sanitation Management Act, food additive,
scope of special dietary food should be sent food in tablet and capsule forms, shall not
to the Department for review and approval. be manufactured, processed, prepared,
Names of food items that are qualified can repacked, imported or exported without
be found on the food information website. being inspected, registered and permit

Management of Food and Drugs 57

 licenses issued.
(2) B y r e g u l a t i o n s o f t h e H e a l t h F o o d
Management Act, health food shall not
be manufactured, imported, labeled or
advertised as health food, or emphasized
a s h a v i n g h e a l t h p r o m o t i o n e ff e c t s ,
unless they are inspected, registered and
approved. Since December 31, 2007, the
registration and market approval of health
food is done in two tracks.
Section 2 Management of
Controlled Drugs
To prevent the legal controlled drugs from
being used illegally, and to conduct prevention of
substance abuse, the Bureau of Controlled Drugs
of the Department had promoted the following
activities in 2008.
1. Management System of Controlled Drugs
To control the flow of controlled drugs in
country, a management system of controlled drugs
is set up; a management by schedule of controlled
drugs is established; and a license management
and inspection is practiced.
1) C o n t r o l l e d d r u g s a r e m a n a g e d a t f o u r
schedules by their addiction, dependence,
abuse, and social hazards.
2) A m a n a g e m e n t s y s t e m o n t h e f l o w o f
controlled drugs is established; a licensing
management system is practiced. Companies
or institutions concerned must apply for
registration licenses of controlled drugs
before the drugs can be imported, exported,
manufactured, sold and purchased. In 2008,
12,462 institutions concerned had been issued
registration licenses for controlled drugs; and
58 2009 Taiwan Public Health Report
39,503 physicians, dentists, veterinarians, and
assistant veterinarians had been issued use
licenses for controlled drugs.
3) Workshops for seed workers on laws and
regulations concerning the management of
controlled drugs have been organized to train
the employees of local competent health
authorities for their skills in the promotion of
laws and regulations concerning the control
of controlled drugs.. Online learning curricula
on outlines of laws and regulations concerning
controlled drugs are posted on the Taiwan
e-learning website (http://elearning.taipei.gov.
tw/) for the learning of professional medical
personnel.
4) Auditing and inspection of controlled drugs
(1) Control of controlled drugs: For the
manufacturing, import, export of controlled
drugs, and their use in medical and
pharmaceutical teaching, research and
experiment, permit licenses, letters of
agreement or approval should be applied
for. In 2008, 1,953 such applications had
been approved. The purpose is to control
controlled drugs from the sources of origin
to prevent them from being illegally used.
(2) Reporting and auditing of the flow of
controlled drugs: A controlled drug
management information system is set
up; the practice of online reporting of the
flow of controlled drugs is promoted to
facilitate the establishment of databases
on the flow of controlled drugs. In 2008,
98.81% of the dealers had used the online
reporting; and the institutions using online
reporting had increased from 71.48% in
2007 to 84.90% in 2008. The Controlled
Drug Management Information System is
 used for auditing and inspection of the flow
of controlled drugs; and on-spot inspection
is carried out for any unusual behavior.
In 2008, on-spot inspection had been
carried out 16,241 firm-times, to find 270
firms in violation of regulations, at a law-
breaking rate of 1.66%. Firms in violation
of regulations are processed in accordance
with regulations of relevant laws to prevent
the misuse, abuse or use for other purpose
of controlled drugs.
2. Prevention and Control of Drug Abuse
Abuse of the emerging drugs has become
a killer of the new generations. To protect the
health of the people, the government has actively
promoted various control measures against drug
abuse; set up drug abuse reporting systems; and
conducted diversified educational activities on the
prevention and control of drug abuse.
1) A 2008 Symposium on the Prevention of the
Abuse of Emerging Drugs was held. Experts
from Japan, the Netherlands, and the US
were invited for keynote speeches to facilitate
international cooperation and exchange of
information on drug abuse.
2) More educational materials, videos and
teaching materials are produced focusing
on different ethnic groups and age groups
for distribution to governmental and private
organizations in the prevention of drug abuse.
3) To establish a community-based publicity
network for the prevention of drug abuse,
a series of activities on the theme of“fight
against drugs with love; healthy life”have
been organized in communities in collaboration
with local groups, primary schools, and health
bureaus.
4) To improve the knowledge of the public on
the hazards of drug abuse, education on drug
abuse has been intensified in collaboration
with 29 community and private organizations.
Of the 7,096 copies of questionnaire returned,
the knowledge of the public on drug abuse has
improved by 10%.
5) An Internet Museum of Anti-Drug Resources
is set up to provide the public with information
on hazards of drug abuse. An online learning
program is developed.
6) More medical institutions have been supervised
to participate in the reporting of drug abuse.
This practice is also made one of the items for
the evaluation of local health organizations.
7) Statistical data on drugs seized and abuse of
controlled drugs are compiled; trends of drug
abuse and emerging drugs are monitored; data
on cases of drug abuse and laboratory testing
are compiled and published for the reference
of organizations concerned.
8) In collaboration with the Ministry of Justice,
local drug abuse prevention centers are
supervised for case referral. A joint inspection
program of local drug abuse prevention centers
is carried out to inspect the county/city centers.
3. Laboratory Testing for Drug Abuse
Laboratory testing of abused drugs is one
important link in the prevention of drug abuse.
Major activities in 2008 are as follows.
1) Specimens of drug abuse referred by judicial,
prosecution, police and health authorities are
tested. In 2008, 1,250 non-urine specimens
were tested, to find methamphetamines
in most of them, Ketamine the next, and
benzodiazepine the third. Distribution of the
drugs detected in non-urine specimens is
Management of Food and Drugs 59
 shown in Figure 5-1.
2) Accreditation and management of urine-
testing institutions: 13 institutions have
been accredited. Items accredited include
methamphetamines, amphetamines, morphine,
codeine, MDMA, MDA, marijuana and
Ketamine. These institutions have conducted
urine testing for 187,295 cases, an increase of
11.6% over 2007. The testing coverage rate
for urine specimens is as high as 99.9% (Figure
5-2).
3) To improve the credibility of testing and to
enhance self-capacity, on June 21, 2008, the
Bureau passed two accreditations,“testing of
urine specimens”and“testing of controlled
substances”, of the ASCLD/LAB. On June 26
of the same year, the Bureau also passed the
accreditation of the TAF (Taiwan Accreditation
Foundation) on“urine testing for controlled
drugs and illegal drugs”and“testing of
controlled drugs and illegal drugs”. The
Bureau is the first laboratory in country that
has won accreditation of ASCLD/LAB and TAF
Section 3 Laboratory Testing
for Food, Drugs and
Cosmetics
Drugs, medical devices, medicated cosmetics,
food additives, health food, and genetically
modified food must apply for registration and pre-
market approval. They may be manufactured,
imported or sold only after being issued permit
licenses. Product testing should be conducted
to assure quality and safety. Biological products
such as vaccines and botulinal toxins, and blood
products must be, in addition to the application for
permit licenses, batch-tested for sealing before
marketing. Upon sudden incidents of drugs, food
and cosmetics, laboratory testing for confirmation
is also required.
To effectively utilize private laboratory testing
resources, accreditation of laboratories has
been actively promoted with a view to supervise
the operation of laboratories by international
standards to assure the quality of testing.
1. Laboratory Testing

at the same time. Laboratory testing of food and drugs is for

Figure 5-1 Distribution of the Drugs Detected in Non-Urine Specimens, 2008

Methamphetamine PMMA
409(32.7％) 4(0.3％)

Benzodiazepine Marijuana
81(6.5％) 1(0.1％)
Total: 1,250
Ketamine Heroin
255(20.4％) 46(3.7％)

MDMA Others
22(1.8％) 184(14.7％)

Not detected
248(19.8％)

60 2009 Taiwan Public Health Report

policy implementation on one hand, is also to customs authorities to levy duty on imported
support the routine laboratory testing of local goods, manufacturers for product certificates
health bureaus and other testing organizations; for export, assistance to judicial courts,
and to conduct laboratory testing on the quality prosecution, police and customs authorities for
and safety of products on market. the testing of confiscated drugs or food.

1) Administrative testing: Testing is conducted 4) In 2008, a total of 12,871 samples had been
for product registration, market approval and tested. Of them, 855 samples were for product
issuance of permit licenses; and batch-testing registration and pre-market approval, 364
for sealing for vaccines, blood products, samples were for batch-sealing, 2,054 samples

botulinal toxins; and testing of emergency were for inspection, 2,675 samples were for

incidents such as residues of Ractopamine consumer services, 985 samples were for

in pork, and melamine-contamination of milk food poisoning incidents, 1,093 samples were

powder. for assistance to other organizations, 151

samples were tested upon request of other
2) S u p p o r t t o c o u n t y / c i t y h e a l t h b u r e a u s :
organizations, and 4,694 products on market
Sampling testing for inspection, consumer
had been tested through surveys (Figure 5-3).
protection, and testing for food-borne
Results of laboratory testing are posted on the
outbreaks.
Bureau of Food and Drug Analysis website
3) Supportive testing: Testing is conducted and the Consumer Information Network of
upon request of organizations such as the the Department for reference of consumers in

Figure 5-2 No. and Coverage of Urine Testing by Accredited Testing Institutions by Year

Total No. of urine-specimens Total No. of urine-specimens tested Coverage rate

tested by accredited institutions

No. of Testing Coverage Rate

99.61％ 99.94％
98.56％
250,000 100.00％
90.98％
90.00％
213,441 82.53％
78.93％ 78.55％
200,000 80.00％
198,539 184,470 181,816 187,406 187,295

168,466 163,848 168,279 168,495 167,835 70.00％

157,189 153,100
150,000 60.00％

123,474
50.00％

100,000 40.00％

30.00％

50,000 20.00％

10.00％

0 0.00％
2002 2003 2004 2005 2006 2007 2008 Year

Management of Food and Drugs 61

 Figure 5-3 Types of Laboratory Testing for Drugs, Foods and Cosmetics, 2008
Total: 12,871
selecting products. Unqualified products are
processed by local health bureaus to enhance
the management and supervision of products
before marketing.
2. Quality of Laboratory Testing
To establish a strict and efficient quality of
laboratory testing, the Good Laboratory Practice
(GLP) is actively practiced. The Bureau has
passed the accreditation of the TAF. Testing
capacities of county/city health bureaus have
been upgraded.
1) GLP is actively promoted. In coordination with
the government policy in joining the WTO,
county/city health bureaus are supervised to
set up the GLP systems. All 25 health bureaus
have passed the accreditation of TAF.
2) A regional integrated laboratory testing system
for local health bureaus is established. The
Central, Southern, and Northern Region
Integrated Systems are now in operation.
Each system develops its own specialty testing
items for mutual support. By sharing resources
62 2009 Taiwan Public Health Report
Testing of products Testing for service
on market 2,675(20％)
4,694(36％)
Testing for registration and Testing for food
pre-market approval poisoning outbreaks
855(7％) 985(8％)
Testing for batch-sealing Testing in support
364(3％) 1,093(9％)
Testing for inspection Testing upon request
2,054(16％) 151(1％)
and expertise, testing efficiency is upgraded.
3) Accreditation of private sector laboratories
is promoted. By international accreditation
standards, the accuracy of testing results
is assured, and the quality of testing is
upgraded. By 2008, 18 laboratories had been
accredited for the testing of food, and three
laboratories had been accredited for the testing
of drugs and cosmetics. Items accredited
for the testing of food include residues of
pesticides, veterinary drugs, heavy metals,
food additives, food components, dioxin, and
microbes. Items accredited for the testing of
drugs and cosmetics include hydroquinone,
salicylic acid, tranexamic acid, aerobic plate
count, Staphylococcus aureus, Pseudomonas
aeruginosa, and Escherichia coli.
4) To improve the skills of local laboratory testing
and inspection personnel, training programs,
workshops, online learning, and proficiency
testing relevant to inspection and laboratory
testing have been organized.
 64︱Section 1 Health Care Systems

66︱Section 2 Quality of Medical Care

68︱Section 3 Psychiatric Care and

Mental Health

Health
6
70︱Section 4 Long-Term Care
Service Systems
Care 71︱Section 5 Quality of Nursing Care

72︱Section 6 Emergency Medical

Care

72︱Section 7 Health Information

74︱Section 8 Medical Manpower

 6 Health Care
Along with the rapid changes in health
and medical care, and social and economic
environment, how the medical care systems and
medical care teams can best assure the public
of safe medical care has become a challenge of
today. How to provide a holistic and adequate
health care system to the people, how to realize
community medical care and preventive health,
and thus to improve the health of the people and
their quality of life are some of the current key
issues.
Section 1 Health Care Systems
In 1985, in coordination with the promulgation
of the Medical Care Act, a medical care network
plan was promoted. Taiwan was then divided
into 17 medical care regions to plan for medical
care manpower and facilities in each region.
The primary goals of the plan are to balance the
distribution of medical care resources, to shorten
regional differences, to avoid repeated investment
of medical care resources, and thus to elevate
medical care standards by region.
The plan has been implemented in four phases.
In the last 20 years, the number of hospital beds
has gradually become sufficient; the quality of
medical care has been upgraded. However,
medical care resources in mountain areas and
offshore islands require further strengthening;
and the quality of primary care still has room for
improvement. In coordination with the post-SARS
64 2009 Taiwan Public Health Report
reform of medical care systems, and to face the
impact on Taiwan brought about by the aging
of population and the emerging communicable
diseases, and to promote holistic health care at
the same time to assure the safety of patients,
and to construct a patient-centered medical care
environment, a holistic health care plan was
implemented in 2005-2008. Key issues of the
plan include the strengthening of regional medical
care systems, upgrading of the service quality
of primary care, planning of medical manpower
and improvement of their professional quality,
improving quality of medical care, strengthening
of the external monitoring mechanism for medical
care quality, and implementation of medical care
programs for special groups. To continue the
holistic health care plan, a health navigation plan
for the new cohorts will be implemented in 2009.
1. Medical Care Resources
To promote the balanced development of
medical care resources, by the Medical Care Act
and the medical care network plan, a regional
medical care system is established to promote
regional medical care plans in accordance with
the needs of the people. Achievements in 2008
are as follows.
1) Current status of medical institutions: In
2008, there were 515 hospitals, and 19,659
clinics (Figure 6-1). The number of hospitals
is declining; whereas the number of clinics is
increasing.
2) Current status of hospital beds: In 2008, there psychiatric beds, 13,661 chronic psychiatric
were 152,091 beds in medical care institutions beds, 48 tuberculosis beds, and 300 beds for
(including general beds and special beds). Of Hansen's disease). On average, there were
them, general beds accounted for 64.41%. In 66.37 beds per 10,000 population; the goal
all medical care institutions, there were 97,958 of the medical care network plan has been
general beds (including 73,426 acute general achieved. Changes of the bed/10,000 ratio by
beds, 3,928 chronic general beds, 6,595 acute year are shown in Figure 6-2.

Figure 6-1 No. of Hospitals and Clinics by Year

No. of hospitals No. of clinics

No. of hospitals No. of clinics
900 20,000
828 19,659
17,413 19,370
800 787
773
17,012 17,070 18,650 18,877 19,135 18,000
750 18,183
17,628 17,618
719
700 16,648
700 16,000
669
15,872
637
14,924 15,322 610 14,000
600 594 590
556 547
530 12,000
515
500
10,000
400
8,000
300
6,000
200
4,000

100 2,000

0 0
1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 Year

Figure 6-2 No. of Hospital Beds per 10,000 by Year

No. of Beds
35

30 Acute general Beds

25 Acute psychiatric Beds

Chronic general Beds

20
Chronic psychiatric Beds
15
Special beds

10 Hemodialysis beds

0
1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 Year

Health Care 65
 3) The Medical Care Development Fund: In the
period 1992 till end of 2008, a total of 313
medical care institutions had been subsidized
by the Fund. In addition, in 20 districts, to
encourage medical personnel to practice in
remote areas of relatively poor resources,
subsidies had been made available to improve
emergency care. To improve the quality of
medical care services, six small-scale hospitals
were subsidized to set up a joint practice model
with clinics. 16 hospitals had been subsidized
to improve their capacity and upgrade medical
care quality to provide integrated medical care
services to the elderly.
2. Community Medical Care System
Medical care systems have been reformed after
the SARS outbreaks. Since 2004, community
public health (disease control) groups have been
established on trial basis to promote prevention
and health promotion in community, to integrate
resources of disease control and medical care and
resources of private and public sectors. By the
establishment and strengthening of community
public health (disease control) groups, interaction
between local health bureaus/health stations and
community medical care groups (formed by clinics
and their collaborative hospitals) is enhanced to
jointly promote health, medical care and disease
control, and to solve the health problems of the
community. Since 2005, a pilot project, integrated
services by the community public health (disease
control) groups, has been tried out. In this
project, community hospitals, clinics, and health
stations join together in a community medical
care network to provide comprehensive holistic
medical care by establishing household files,
reviewing medical care needs of the residents,
and providing adequate referral services to fully
practice the functions of family medicine systems.
66 2009 Taiwan Public Health Report
In 2008, 305 community medical care groups and
43 public health (disease control) groups had
been established. A regional shared care network
of“good physicians and good hospitals”in the
neighborhood has thus been established.
3. Medical Care Services of DOH-Hospitals
1) The Great Warmth project is promoted. In
2008, a total of NT$ 4,243,866 were made
available for subsidies to help the less-
privileged families. A total of 1,094 cases had
been referred for care.
2) Strengthening care of the elderly
(1) Nursing homes and centers for the care
of dementia elderly have been set up. In
total, 2,326 beds in nursing homes and 150
beds in the centers for dementia elderly
have been made available.
(2) Service teams for hospice and palliative
home care have been set up to provide
holistic hospice and palliative home care
to reach the goal of allowing the elderly
suffering from cancer to age in their familiar
neighborhood. Such services are now
provided by six DOH-hospitals of Hsinchu,
Taichung, Fengyuan, Nantou, Tainan and
Penghu).
3) The first BOT hospital, the Shuanghe Hospital,
started operation on July 1, 2008. The contract
is till March 7, 2054.
Section 2 Quality of Medical
Care
To protect the safety of patients, to upgrade
the quality of medical personnel, to strengthen
management of hospitals, to continue the external
quality monitoring of hospitals, and to establish a
national hemodialysis medical care resources and
control of blood quality system are some of the
pressing matters of the moment.
1. Quality of Medical Care Services
The goals are to establish a patient safety-
oriented medical care environment, to plan for
a new hospital accreditation system, to develop
safety surveillance of patients and a safety
incidents reporting mechanism. Achievements are
as follows.
1) Patient Safety and Quality of Medical Care
(1) Annual objectives for the promotion of
patient safety and quality of medical care
in hospitals for 2008-2009 have been
formulated. Health bureaus are asked
to supervise hospitals in their jurisdiction
to include these objectives in their
assessment.
(2) A Taiwan Patient Safety Reporting System
(TPR) is set up to realize patient-centered
medical care, and to establish a non-
punitive learning environment to avoid the
repeated occurrences of errors.
(3) A patient safety website is set up to
provide patients with the latest information
on safety and to serve as a platform for
interaction.
2) The Hospital Accreditation System
Reform of the accreditation of hospitals and
teaching hospitals is made on the direction
of“patient-centered”and“priority on patient
safety”.
(1) The key points of the new accreditation
system focus not much so on structural
assessment but more on the assessment
of process and performance to break the
myth of“the larger hospital the better; the
more departments the better”. Hospitals
are encouraged to develop different types
of specialties focusing on the health needs
of the community residents. Reform of
the accreditation system for teaching
hospitals focuses on the development
of teaching plans as a principle to place
more emphasis on process of teaching
and training, and their outcomes, and
thus to improve the manpower quality of
physicians and medical personnel, and to
improve the overall quality of medical care.
(2) A“scheduled but not on fixed time”plan
for follow-up supervision and inspection
is practiced. A“patient-centered”safe
care environment is established to improve
the quality of medical care. In 2008,
476 hospitals passed the accreditation,
accounting for 93% of all hospitals. 22
hospitals had been followed-up for
supervision and inspection.
(3) Accreditation of psychiatric hospitals and
psychiatric rehabilitation institutions is
conducted. 25 psychiatric hospitals and 82
psychiatric rehabilitation institutions have
been accredited.
(4) Accreditation of Chinese medicine hospitals
operated by responsible physicians with
two and more years of medical training is
conducted. On August 4, 2008, names
of 12 qualified hospitals for training were
announced.
3) To upgrade the quality of the pre-practice
training of dentists, a plan on the training of
dentists two years prior to independent practice
was initiated in 2008. Training curricula,
qualifications of teachers, and standards for
the authorization of training institutions will be
decided by the end of 2009.
Health Care 67
 2. Environmental Protection Measures in
Hospitals
1) A t p r e s e n t , t h e r e a r e s i x d i s p o s a l a n d
management institutions set up under the
supervision of the Department for joint
disposal of wastes. Two of them apply the
sterilization method for disposal, and the rest
have incinerators. In May 2005, a medical
waste joint disposal institution was approved
to recycle by electrolysis developing and fixing
fluid produced by medical institutions to solve
the problems of disposing these substances of
hospitals.
2) To reduce wastes and recycle them for use,
the Department has, since 2000, through a
demonstration project on waste reduction
and resource recycling, supervised medical
institutions to take initiative in properly
handling and managing their medical wastes.
One company for the recycling of wastes is
approved and issued license for operation to
recycle medical wastes containing metals.
3. Improving the Quality of Blood Supply and
Transfusion
In January 2006, the Blood Products Act
and their implementation regulations were
promulgated. With this, the national blood service
is further strengthened; the quality of blood for
medical use is upgraded; and the safety of blood
transfusion is further guaranteed.
1) New sources of blood are developed actively;
the first-time blood donation rate is improved.
At present, there are more than six million
blood donors, at a blood donation rate of
7.86%. In the last eight years, the average
amount of blood donated each year is
2,267,739 bags.
2) Automation of laboratory testing for blood is
68 2009 Taiwan Public Health Report
strengthened to reduce the re-examination
rate and to avoid the occurrence of reading
errors, and thus to improve the quality of blood
operation and protect the safety of blood
recipients.
3) About 0.73% of the population in Taiwan
carries variety amounts of antibodies in red
blood cells. Hemolysis often occurs after blood
transfusion. For this reason, screening of
blood donors for antigens in red blood cells is
conducted to effectively improve the chances
of patients of rare blood types to receive
adequate blood for transfusion, and thus to
improve the safety of blood transfusion.
Section 3 Psychiatric Care and
Mental Health
As a result of social transformation, human
relationship has become more distant; and
social and mental problems have increased
day by day. Prevention of psychiatric disorders
and enhancement of mental health have thus
become important issues of concern. For this, the
Department has spared no efforts in promoting
medical care for psychiatric patients, in planning
for mental health services, in providing the public
with counseling on mental health, and thus to
prevent the occurrence of post-trauma stress
syndromes and other psychiatric disorders.
1. Psychiatric Care Services
To strengthen the care network and to help
psychiatric patients return to the community,
community rehabilitation services have been
actively promoted. Major activities in 2008 are as
follows.
1) Governments at various levels and private
sector organizations are subsidized year
 by year to strengthen their equipment and
facilities for psychiatric care, rehabilitation, and
psychiatric nursing care, and thus to make
psychiatric care more accessible to patients.
Thus far, 5 psychiatric rehabilitation institutions,
and 4 psychiatric nursing homes have been
subsidized.
2) To encourage psychiatric patients of stable
conditions, patients with partial functional loss,
and patients of good rehabilitation potential
to return to the community, rehabilitation
facilities have been substantiated to strengthen
community rehabilitation services. By the end
of 2008, the community rehabilitation centers
had served 3,151 patients; and the half-way
houses had 3,728 beds.
3) To u n d e r s t a n d t h e c a r e o f p a t i e n t s i n
community, registration of the community
follow-up care systems for psychiatric patients
in 25 counties and cities have been made.
Currently, 98,665 cases are placed under
management, follow-up and home-visit.
Figure 6-3 No. of Suicide cases and Mortality Rate by Year
No.of Death 65+ 45-64
5,000 14- Crude death rate
4,500
4,000
3,500
3,000
2,500
2,000
1,500
1,000
500
0 0.00
1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 Year
Note: Dotted line stands for the standardized mortality rate adjusted by the age-structure of the 2000 world standard
population.
4) 25 counties and cities have been subsidized
to set up community mental health centers to
provide the community residents with mental
health care, counseling and education.
5) 111 institutions have been designated by the
Department for drug addiction treatment.
Of them, 6 are core hospitals, 98 are drug-
cessation hospitals and 7 are drug-cessation
clinics.
2. Prevention of Suicide
The suicide death rate of Taiwan had increased
from 6.2 per 100,000 in 1994 to 17.9 in 2008 (see
Figure 6-3 for the number of suicide and death
rate by year). For 12 consecutive years, suicide
has been on the list of the ten leading causes
of death. With the September 21 earthquake,
the SARS outbreaks, and the global economic
recession, people are facing more health, social
and economic impact, and the entire environment
has become less favorable to the prevention
of suicide. For this, the Department has made
25-44 15-24 Mortality / 100,000
Standardized death rate 20.00
15.00
10.00
5.00
Health Care 69
 suicide prevention a priority task.
1) In 2005, a national action plan on strategies
for the prevention of suicide was approved by
the Executive Yuan. The plan is formulated on
the concept of prevention in three stages and
by five levels. Short, mid and long-term goals
of suicide prevention are drafted from three
dimensions of comprehensive, selective and
indicative.
2) A suicide prevention reporting and concern
system is set up to report home visiting and
referral of suicide cases to health bureaus and
the Department. In 2008, 24,180 cases had
been reported.
3) In December 2005, a suicide prevention center
and a 24-hour hotline, 0800-788995, were
set up to provide the public with professional
counseling services. In 2008, 48,127 calls had
been received.
4) In collaboration with the community mental
health centers, the community support
network has been activated; the shared care
network for depression has been expanded;
and training and certification of professional
personnel have been intensified. Meetings
have been held to improve the reporting for
suicide prevention and their follow-up visits.
70 2009 Taiwan Public Health Report
Section 4 Long-Term Care
Service Systems
Community long-term care systems have
been developed to allow functionally disabled
individuals in community to maintain independent,
autonomous, safe and dignified life capacity.
Special care models have also been developed
to provide the mentally and physically impaired
with comprehensive care services. Details of the
services will be illustrated in Chapter 7.
1. Strengthening Community-Based Long-
Term Care
Along with the aging of population, prolongation
of life expectancy, changes in disease patterns,
and the sharp increase in the number of disabled
persons, demands for long-term care have
increased drastically. To meet these demands,
the Department has actively promoted the long-
term care services systems to provide the public
with integrated, accessible and continuous care
services.
1) A diversified long-term care service network
is developed to strengthen care resources
in community. Focusing on community care
and supported by institutional care, hospitals
and nursing homes are supervised actively
 to provide home care services. At present,
there are 347 nursing homes, 484 home care
institutions, and 17 day care centers.
2) A care management system is set up. 25
counties and cities are supervised to set
up long-term care management centers to
integrate social and health resources for long-
term care. These centers serve as a single
window for linking and delivering long-term
care services. In these centers, 21 stations
are set up and staffed with 302 professional
workers. Workshops have been organized to
upgrade the professional skills of workers.
2. Services for the Mentally and Physically
Impaired
1) A p i l o t p r o j e c t o n t e l e - c a r e , i n c l u d i n g
community-based care, home care and
institution care, has been tried out since 2007.
People under different service models can thus
avail themselves to continuing care services.
2) 21 district and above teaching hospitals
have been subsidized to set up auxiliary aid
centers to provide services in the professional
assessment of auxiliary aid, counseling, and
individualized designing. Patients are also
given training and education.
3) 25 hospitals are commissioned to implement
a joint child development assessment center
plan to develop an accessible service network
for the assessment of the development of
children.
Section 5 Quality of Nursing
Care
1. The total nursing care system is promoted.
Through supervision, hospitals are asked to
practice total nursing care, and to establish
a collaborative model between nurses and
nursing assistants to reduce the workload of
nurses, to improve quality of nursing care,
to minimize chances of friends and relatives
keeping company of patients, and thus to
reduce the burden of families on the care of
patients.
2. Action has been taken to improve the work
environment of nursing personnel and
encourage them to stay on job. In 2008, 12
medical care institutions, nursing and midwifery
institutions, organizations concerned, and
colleges and universities took part in the
development of indigenous strategic models to
help hospitals encourage nursing personnel to
stay on job.
3. Continuing education for nurses is promoted.
In 2008, seven nursing professional groups
had been subsidized to develop continuing
education curricula for various specialties. In
coordination with the promulgation on June 20,
2008, of the Regulations Governing Practice
Registration and Continuing Education
of Nursing Personnel, four professional
nursing associations were designated by the
Department on October 31 as authorized
executing units of continuing education.
Specifications on the review of curricula and
credits for the continuing education of nursing
personnel have been formulated.
4. A specialty professional registered nurse
system is promoted, and review of specialty
nurses is conducted. 68 hospitals have been
approved for the training of nursing personnel
in internal medicine and surgery. Continuing
education for specialty professional registered
nurses is also organized.
5. A project to supervise post-partum nursing
homes is commissioned out. 69 such homes
Health Care 71
 have been supervised for reference in the
accreditation, management and policy-making
on post-partum nursing homes.
6. A continuing education system for midwifery
personnel is promoted. In coordination with the
Regulations Governing Practice Registration
and Continuing Education for Midwifery
Personnel, practicing midwives are required to
renew their licenses on April 15, 2011.
7. Training is offered to nursing leaders from
14 countries. Taiwan's quality experience in
nursing care is shared, and at the same time,
Taiwan's international visibility in health matters
is enhanced.
Section 6 Emergency Medical
Care
In order to ensure the sound development of
emergency medical services system, improve
the qualities of emergency medical services, and
secure life and health of the injured and ill patients
in emergency, the Emergency Medical Service Act
was amended and promulgated on July 11, 2007.
1. To immediately monitor and access the
regional catastrophes and emergency medical
disasters, 6 Regional Emergency Operation
Center (REOCs) around Taiwan（Taipei,
Taoyuan, Taichung, Tainan, Kaohsiung, and
Hualien）have been constructed to timely
integrate and allocate the resources in case of
difficult times.
2. An“intensive care bed reporting system”has
been established to provide an invigorate
emergency care system and a fluent patient
flow.
3. A“poisonous, chemical and nucleic hazard
system”was also built to enhance the
72 2009 Taiwan Public Health Report
response capabilities and to fortify the
professional personnel, protective equipment
and facilities as well as the disasters.
4. 2,767 people were educated ever since 2008
via the 62 CPR & AED (Cardiopulmonary
resuscitation and automated external
defibrillator) emergency education classes
promoted by the Department, especially in
the hustle and bustle public places and scenic
spots.
5. To improve the quality of ambulances services
and to assure that disaster response measures
are properly practiced by local health bureaus,
the management of ambulances and the drills
on the rescue of mass casualties are included
in the evaluation items for local health bureaus.
Section 7 Health Information
Following the National Health Informatics
Project (NHIP, 2008 to 2011) that was approved
by the Executive Yuan in August 2007. This work
is continued to develop major health information
infrastructures, to improve medical care quality
and patient safety, and to enhance use efficiency
of medical care resources.
1. The National Health Informatics Project
(NHIP)
1) Promotion of Electronic Medical Records
(EMR)
To enhance the willingness of medical care
institutions in promoting electronic medical
records, the Department has formulated
promotional strategies in four dimensions of the
legal, standards, security and promotion. On
December 25, 2008, the set of Regulations of
EMR Production and Management by Medical
Institutions was amended and announced. The
Regulations specify that the date and scope of
EMR implementation should be clearly announced
and posted by medical institutions. In addition,
the forms and standards for 30 electronic medical
records and templates for inter-hospital EMR
exchange were revised, and 20 hospitals were
advised and subsidized to pass the certification
of the ISO 27001:2005 information security
management system.
2) Healthcare Certification Authority
The Healthcare Certification Authority (HCA)
was inaugurated on June 13, 2003, to provide
certification services in electronic medical
documents. By the end of 2008, a cumulative
total of 167,939 electronic certificate IC cards had
been issued. The card is used for the promotion
of electronic medical records, to serve as a portal
for the health information herald system, to serve
as the regional healthcare information platform,
for use in multi-credential online the National
Health Insurance enrollment and withdrawal
registration system, online childbirth reporting
system, exchange of electronic official document
exchange system of medical care institutions, and
reading of information on the medical columns of
the National Health Insurance card.
3) Public Health Information Service Platform
A service-oriented Public Health Information
platform and its portals have been set up to
integrate and connect all Public Health Information
systems between the Department and its affiliated
institutions, to promote the health information
exchange or data sharing, and to reduce repeated
data input of information. In 2008, inventories of
the Public Health Information systems of health
institutions were taken; and the information
integrated application service architecture was
planned.
4) Value-Added Use of Health Information
In 2008, a program to establish a collaborative
center for the value-added use of health
information was implemented to consolidate
individual information into collective information
for practical utilization, and thus to promote the
quality of policy-making in public health, and
also for reference of academic research and
innovation.
2. Health Information Services
1) Health Information Services
Various systems for service, application
and management of health information are
planned; cross-organizational flow of information
is strengthened; and efficiency of healthcare
services is enhanced. Achievements in 2008 are
as follows.
(1) On December 1, 2008, the medical affairs
management system was renewed and
put online. The system is to provide
the Department and the health bureaus
with information for the management of
medical affairs, pharmaceutical affairs,
management of nursing/midwifery and
psychiatric rehabilitation institutions, and
management of medical personnel and
their administrative disciplinary measures.
The system is connected to other relevant
systems for information exchange and
sharing.
(2) F u n c t i o n s o f t h e o n l i n e a p p l i c a t i o n
systems of medical personnel reporting for
supporting services are maintained. In the
year, 2,027 hospitals have taken part in the
operation to process 118,564 cases.
(3) The operation of the reporting platform of
ICU empty beds and deaths is maintained.
Health Care 73
 In 2008, 203 first-aid responsibility
hospitals and 191 hospitals reporting the
number of empty beds in ICUs and deaths
in hospitals, respectively, to this platform.
(4) Functions of the reporting systems of
psychiatric care, suicide prevention and
assessment of mental and physical
impairment are revised and maintained
to improve follow-ups of cases. In 2008,
1,935 cases for psychiatric care, 24,760
cases for suicide prevention, and 66,734
cases for assessment of mentally and
physically impairment had been reported.
(5) Functions of the websites of the 355 health
stations are maintained for the public to
search online for relevant information
on healthcare. A cumulative total of
32,587,907 person-times have visited
these websites.
(6) The public online service systems continue
to provide application forms on medical
affairs, pharmaceutical affairs and food
sanitation for downloading, to inquiring
about the progress of processing, and
notifying applicant to collect the certificate
back. The systems are connected to the
shared electronic payment platform of the
Research, Evaluation and Development
Commission of the Executive Yuan, and
the fee-payment systems of banks and
convenience stores.
(7) On March 18, 2008, the the automatic
comparison function of the certification
management system was officially placed
online. By the end of 2008, 54,816
documents and 499,938 pieces of goods
had been processed.
74 2009 Taiwan Public Health Report
(8) The Food Safety Management Information
System is continued to be amended and
maintained for strengthening the control of
food safety and the reporting of inspection
cases. By the end of 2008, 275,241
inspections had been processed.
(9) By the end of 2008, the drug interaction
system had been visited by, 123,028
person-times of medical personnel from
3,076 medical institutions.
2) Health Information Network
The Health Information Network (HIN) is
the national hub for the exchange of health
information (Figure 6-4), to provide functions in
the exchange and sharing of health information.
The Service Center (SC) is responsible for the
operation and management of various public
information systems, and also for providing
counseling services to the linking institutions.
The SC is also responsible for the management
of the network and information security; and at
the same time, conduct visits and supervision on
the information environment of health bureaus
and health stations, and assist in upgrading the
efficiency and quality of information management
of these primary healthcare units, and reduce
digital divide between the urban units and the rural
units s.
Section 8 Medical Manpower
The size and quality of medical manpower have
impact on the quality of medical care services and
the accessibility to medical care resources. For
this, the Department has continued to conduct
projects related to the distribution of medical
manpower and their training to realize the sound
operation of the medical care system.
 Figure 6-4 Framework of HIN Network

Intranet
Internet Department
DOH of Health Subsidiary
T3
(reserve) organs

T3 E1
T3
or ADSL
(reserve)

T3 SC FTTB
E1 Health bureau
GSN 45Mb 100Mb
(Internet) GSN VPN
ADSL
FireWall

E1 E1
E1 E1 Health Station
(reserve) E1
F TTB
STM-1
50Mb
2M PVC
NB CD
NHI IDC CHT CDC
STM-1
HiLink

HCA
ADSL
NHI information
Faculty
Network Code Area medical
society

1. Current Status of Medical Manpower personnel, and 54.97 nursing personnel, all per
10.000 population. By the holistic healthcare plan,
By the licensing systems of professional
personnel, there are 14 laws and regulations the goal of 15.7 western medicine physicians per

governing the management of medical personnel. 10,000 has been achieved; and the estimated

They are the Physician's Act, Pharmacist's needed numbers of Chinese medicine doctors,

Act, Midwifery Personnel Act, Dietitian's Act, dentists, medical technologists, medical radiology

Nursing Personnel Act, Physical Therapist technologists, physical therapists, occupational

Act, Occupational Therapist Act, Medical therapists, pharmaceutical personnel, nursing

Technologist Act, Medical Radiology Technologist
Act, Psychology Counseling Personnel Act,
Respiratory Therapist Act, Audiologist Act, Dental
Technician Act, and Language Therapist Act. The
Optometrist Act will soon be drafted.
personnel, and dietitians have also been met.
The number of psychology counseling personnel,
however, is not yet sufficient.
2. Development of Medical Manpower

By the end of 2008, there were 16.03 western To improve the quality of medical personnel,
medicine physicians, 2.25 Chinese medicine on-job training and plans for the development and
doctors, 4.85 dentists, 12.91 pharmaceutical cultivation of various kinds of medical manpower

Health Care 75
 are conducted each year. Major achievements be set up. The number of medical personnel
are as follows. licensed and in practice is shown in Table 6-1.

1) In principle, the number of western medicine
students to be enrolled each year is limited to
1,300. The development of other categories
of medical personnel is done on control basis.
Applications should be made prior to the
establishment of schools; and the applications
are reviewed by the Ministry of Education
for control purpose. Planning for physician
2) Plan for the development of local medical and
nursing personnel has been implemented.
Indigenous peoples and residents on offshore
islands are trained as medical personnel on
government scholarship; they are sent back to
their home towns for service upon completion
of training. In the past years, 256 government
scholarship-sponsored physicians have been

manpower in the future will be based on the trained.

goal of balanced distribution of resources; and 3) Tr a i n i n g o f p h y s i c i a n s o n g o v e r n m e n t

a periodic assessment mechanism will also scholarship is implemented. They are

Table 6-1 Medical Manpower, 2008

Category No. Licensed No. Practicing No. Practicing per 10,000

Physicians 51,647 36,960 16.0

Dentists 14,281 11,187 4.9

Chinese medicine doctors 10,377 5,184 2.3

Medical technologists
18,380 8,384 3.6
(technicians)

Medical radiology technologists

6,593 4,674 2.1
(technicians)

Pharmacists
47,009 28,772 12.9
(assistant pharmacists)

Nursing personnel 344,955 126,792 55.0

Midwives 53,578 274 0.1

Occupational therapists
3,246 2,025 0.9
(technicians)

Physical therapists
9,169 4,716 1.3
(technicians)

Counseling psychologists 1,174 821 0.4

Clinical psychologists 807 674 0.3

Dietitians 5,556 2,259 1.0

Respiratory therapists 1,658 1,379 0.6

Dental mold technicians 2,617 1,101 0.5

Dental assistants 269 43 0.0

Bone setters 4,011 949 0.4

Notes: Licensed No. excluding the dead practicioners.

76 2009 Taiwan Public Health Report

 assigned, upon graduation, to either work
in primary care units or to specialize in less
popular medical specialties. Thus far, 5,868
6) Training of Chinese medicine doctors in Taiwan
physicians have been trained on government
scholarship. 3,267 of them have been
assigned to work in the DOH systems. Since
2005, graduates on government scholarship
are assigned to work in the DOH-hospitals for
six years. They are routinely assigned to work
in remote areas.
7) Plans have been promoted to improve the
4) P r o f e s s i o n a l m e d i c a l s o c i e t i e s a r e
commissioned to conduct screening and review
of specialty physicians to upgrade the quality
of their professional training. Hospitals for the
training of specialty physicians are accredited
and certified every three years. At present,
26 specialties have been announced; of them,
three are sub-specialties of dentistry. By the
end of 2008, 39,036 person-times of physicians
had been qualified and issued certificates.
5) To strengthen in physicians the concept and
capacity of holistic care, to improve the quality
of training of resident physicians, and to realize
the ideal of“patient-centered”holistic care,
a plan for the training of physicians in general
medicine after graduation has been promoted
to offer to patients more comprehensive
medical care services. In 2008, 102 training
hospitals were in this plan.
comes in a 7-year and 8-year undergraduate
training and a 5-year post-baccalaureate
program. The elementary examination for
Chinese medicine doctors was terminated
in 2008; and the special examination will be
terminated in 2011.
clinical training of Chinese medicine doctors to
enhance the teaching, research, training and
practice environments of Chinese medicine.
(1) To realize the clinical training of Chinese
medicine doctors, 24 hospitals have been
subsidized to conduct 35 projects on the
improvement of the clinical teaching and
training in Chinese medicine.
(2) To strengthen the supervisory functions
of the responsible physicians of Chinese
medicine hospitals, to develop Chinese
medicine doctors of holistic care capacity,
and to promote the sound development
of Chinese medicine hospitals, a training
program for responsible physicians
of Chinese medicine hospitals will be
implemented in 2009.
Health Care 77
 Health
Care for 79︱Section 1 Health Care for Residents
of Mountain Areas
the Less and Offshore Islands,

7
Indigenous Peoples and
Privileged New Immigrants

Groups 82︱Section 2 Health Care for the

Economically

83︱Section 3 Health Care for Groups

with Special Health Needs
 Health Care for the Less
7
Privileged Groups
Health care services provided to the groups
less privileged in health on the principle of equality
in health focus on the low-income families, young
children, the elderly 65 years and above, residents
of remote areas or the indigenous peoples, and
people requiring special care (the disabled,
chronic patients, patients under hospice and
palliative care).
The National Health Insurance implemented
in March 1995 aims at minimizing the economic
barriers of the public to medical care, and
improving accessibility to medical care. By
2008, the coverage rate had reached more than
99%, and a large part of the health needs of
the people have been thus met. This Chapter
illustrates by section health care services for
residents of mountain areas and offshore islands,
the indigenous peoples, the new immigrants, the
economically-deprived groups, and groups with
special health needs.
Section 1 Health Care for
Residents of
Mountain Areas and
Offshore Islands,
Indigenous Peoples
and New Immigrants
For their special geographic environment,
living conditions in mountain areas and offshore
islands are, generally speaking, poorer; and
supply of medical manpower is insufficient. They
are a relatively less-privileged group in terms of
medical care resources and health care. The
new immigrants, for language barrier and cultural
differences, are also the less privileged groups in
health.
1. Health Care for Residents of Mountain
Areas and Offshore Islands, and the
Indigenous Peoples
To improve the a c c e s s i b i l i t y,
comprehensiveness and continuity of health
care for residents of mountain areas and
offshore islands and the indigenous peoples,
the Department has taken action with priority
to integrate medical care resources in offshore
islands, upgrade quality of medical care in
mountain areas and offshore islands, strengthen
functions of health stations, and actively promote
the quality of medical manpower and enhance
the emphasis on prevention and control of major
diseases.
1) Improvement of Hardware Facilities in
Mountain Areas, Offshore Islands and
Remote Areas
In 2008, reconstruction, renovation and
repair of 11 health stations (rooms) in mountain
areas and offshore islands had been subsidized
to renovate buildings and prolong their use.
Subsidies had also been made to the repair
Health Care for the Less Privileged Groups 79
 of two helicopter parking lots in mountain
townships. Health stations (rooms) in mountain
areas and offshore islands, and health stations
in plane areas of indigenous peoples had also
been subsidized for the procurement of medical
equipment, information facilities and mobile vans
and motorcycles to improve the quality of medical
care and information facilities of remote tribes and
to shorten differences between the urban and the
rural areas.
2) Continuous Development of Local Medical
Manpower
(1) The plan for the development of medical
manpower in indigenous areas and
offshore islands is continued. Thus far,
686 medical personnel have been trained.
(2) Graduates on government scholarship
are sent back to work in their own
townships. To encourage them to stay
on job, in coordination with the Integrated
Delivery System (IDS) of the National
Health Insurance, medical personnel are
subsidized to stay on after completion of
their duties. At present, 70.78% of these
medical personnel stay on.
(3) Continuing education for physicians
in health stations of mountain areas is
promoted. Training curricula include care
of acute and critically ill patients, alcohol-
cessation, physical therapy, occupational
therapy, and rehabilitation for victims of
family violence and sexual assaults.
3) Promotion of Community Health Building
(1) Community health building is promoted
80 2009 Taiwan Public Health Report
upon the principles of“indigenous”,“health
issues-oriented”, and“setting up
mechanisms”. In 2008, in collaboration
with organizations concerned in tribes
of indigenous peoples and on offshore
islands to promote community health
building; two supervisory centers and 77
community health building centers had
been established.
(2) In 2008, through public solicitation, 46
teams of college and university students
for the promotion of community health
building in mountain areas and offshore
islands during summer vacation had been
subsidized 12,250 person-times.
4) Promotion of Health Information
(1) 143 mobile stations in 17 townships of
indigenous peoples in five counties have
set up the health information systems
(HIS) to improve further the quality of
medical care in remote tribes. Of all
program activities, the“mobile clinics”to
deliver medical care to the tribes and
the more humane registration system
in mother language are two remarkable
achievements to provide more convenient
medical care services to the residents, and
to shorten differences in medical resources
between the urban and the rural areas.
(2) The picture archiving and communication
system (PACS) is set up; and health
information systems are integrated. In
2008, six health stations in Taichung,
Hsinchu, Nantou and Pingtung were
connected to the DOH-Taoyuan Hospital to
 improve the medical care quality in remote
tribes.
5) Protecting Health and the Rights to Medical
Care for the residents of mountain areas
and offshore islands
(1) To improve the accessibility to medical
care, in coordination with the Integrated
Delivery System of the National Health
Insurance, the rights of the residents
on offshore islands to medical care are
protected through support of specialists,
fixed-point clinics on holidays, mobile
clinics, and commissioned-out medical
care.
(2) Four health bureaus in Penghu, Kinmen,
Lienchiang and Taitung are subsidized to
conduct tele-medical care continuously.
6) Emergency Delivery of Patients in mountain
areas and offshore islands
(1) A 24-hour DOH Air Referral Review Center
is set up. In 2008, 318 applications had
been received, and 282 were approved,
at a rate of 88%; and 36 air delivery trips
had been saved. 11 air referral visual
information systems in mountain areas are
newly established to improve the care of
acute and critically ill patients.
(2) A set of Guidelines Governing Subsidies
to Transportation Costs for Delivery of
Critically Ill or Emergency Patients in
Mountain Areas and Offshore Islands for
Medical Care is formulated to subsidize
costs for transporting patients to Taiwan
for medical care. In 2008, 309 emergency
patients had been transported; and 21,974
critically ill patients had been subsidized for
medical care in Taiwan.
2. Health Care for the New Immigrants
1) To protect the reproductive health of alien
spouses, health cards for management are
Health Care for the Less Privileged Groups 81
 established for alien spouses and education on
reproductive health is given. In 2008, cards for
95% of all alien spouses had been established.
Costs of prenatal care for alien spouses who
have not yet established household registration
are subsidized. In total, subsidies have been
made for 9,861 person-times. A plan to provide
translation service on reproductive health for
alien spouses is promoted. 190 health stations
in 19 counties and cities are taking part in this
plan.
2) Alien laborers are required to take health
examinations at designated hospitals prior
to entry into the country, within three days
after entry, and 30 days before and after
employment for six months, 18 months and
30 months. In 2008, 373,105 person-times
of alien laborers had taken the regular health
examinations (excluding the one three days
after entry). The failure rate was 8.54%.
3) Persons holding certifying documents of
permanent residency in Taiwan such as
residency permit for aliens, may subscribe to
the National Health Insurance in accordance
with regulations of the National Health
Insurance Act, and pay insurance premiums
and be issued Insurance IC cards. With the
card, they are then entitled to necessary
and comprehensive medical care services
at contracted medical institutions at time of
illnesses, injuries, child delivery, and accidents.
4) To promote the health of the new immigrants,
the Department has produced educational
materials in different languages on
communicable disease control, management
82 2009 Taiwan Public Health Report
of chronic diseases, and the National Health
Insurance.
Section 2 Health Care for the
Economically
To ensure access to medical care of those who
are unable to pay for the insurance premiums, and
to reduce their burdens, the Department and the
Bureau of National Health Insurance, have taken
measures to assist them since 2008.
1. Subsidies on Insurance Premiums
Governments at various levels subsidize
people of specific less-privileged groups on
insurance premiums. They include the low-income
families, jobless retired servicemen, unemployed
laborers and their dependents, the handicapped
persons, the elderly above 70 years and children
under 3 years of the near-poor households, and
unemployed indigenous peoples under 20 years
and over 55 years. In 2008, some 2.04 million
people had been subsidized at a total of NT$ 15.3
billions.
2. Assistance on Insurance Premiums
1) The Relief Fund: Individuals, who are qualified
by the Regulations Governing Recognition of
Individuals in Financial Difficulty or in Special
Financial Difficulty under the National Health
Insurance, may apply for interest-free loans to
the Relief Fund to pay for overdue insurance
premiums and the self-payment medical costs
due to the insured institutions. The loan will be
paid back a year after. In 2008, 8,708 loans
had been approved, at about NT$ 500 millions.
2) Referral to charity groups: Individuals who or installment payment.
are unable to pay for insurance premiums are
referred, with the assistance of the Department
Section 3 Health Care for
and the Bureau of National Health Insurance,
to public interests groups or individuals for Groups with Special
support. In 2008, 2,672 cases had been Health Needs
successfully referred.
1. Human Rights Protection and Care of
3) Installment payment: Individuals who cannot
Hansen's Disease Patients
afford to pay insurance premiums in full at one
1) On July 18, 2008, the Hansen's Disease
time may apply for installment payment. In
Patient Human Rights Protection and
2008, 248,000 people had taken advantage of
Compensation Act was passed by the
this system.
Legislative Yuan and promulgated by the
4) A s s i s t a n c e P l a n t o t h e e c o n o m i c a l l y -
President of the Republic on August 13 of the
disadvantaged: A plan to assist the
same year. The Act specifies the correct name
economically-disadvantaged was implemented
of the disease to resume reputation, their
in early 2008 by the Executive Yuan to assist
compensation, medical care and nursing care,
the low-income families and marginal low-
planning for a Hansen's disease medical care
income families to pay for their overdue
park, and the establishment of a committee for
insurance premiums and unpaid loans of the
the protection of the human rights of Hansen's
Relief Fund, at a total of NT$ 800 millions for
disease patients.
33,402 persons. They include 32,420 persons
2) Compensation funds of NT$ 492,629,994
of low-income families and 982 persons of the
have been paid to 272 inmates of the Losheng
marginal low-income families.
Sanatorium.

3. Medical Rights of Those Unable to Pay 3) For life care, each patient is given NT$ 18,000
Insurance Premiums per month; of them, NT$ 7,750 per month is for

Individuals not subscribing to the National incidental expenses.

Health Insurance or their insurance premiums

are overdue, at time of critical illnesses, with
the certificate of poverty issued by village/
neighborhood chiefs or hospitals, may avail
themselves initially to medical care as the
insured. After treatment, they will then be, upon
individual conditions, assisted to subscribe to the
Insurance, apply to the Relief Fund, or for referral
2. Prevention and Control of Rare Diseases
The Rare Disease Control and Orphan Drug
Act was implemented in August 2000. Taiwan is
the fifth country in the world after the US, Japan,
Australia and the EU to enact laws and regulations
for the prevention and control of rare diseases.
The Act is primarily to prevent the occurrence

Health Care for the Less Privileged Groups 83

 of rare diseases, to provide early diagnosis and
care of patients of rare diseases, to help patients
access to adequate drugs and special nutrient
food for rare diseases, and to encourage and
ensure the supplies, manufacturing, research and
development of these drugs and nutrient food.
To provide patients of rare diseases with
comprehensive care, rare diseases are included
for payment in the National Health Insurance
under the category of critical illnesses and injuries
and metal and physical impairment. A set of
Regulations Governing Subsidies to the Medical
Care of Rare Diseases is formulated to subsidize
the medical costs of diagnosis, treatment, drugs
and special nutrient food not covered by the
National Health Insurance. A supply center for
drugs and special nutrient food for patients of
rare diseases has also been set up. By the end
of 2008, 167 rare diseases in 153 categories had
been announced; 40 items of special nutrient food
and 81 drugs for rare diseases had also been
announced.
3. Health Care for the Mentally and Physically
Impaired
1) Building a Comprehensive Care Model
To provide the mentally and physically impaired
with comprehensive care, a special care model
has been developed under the long-term care
systems.
(1) 2 5 c o u n t i e s a n d c i t i e s h a v e b e e n
subsidized to provide home nursing care
to allow the functionally disabled elderly
to be cared in an environment familiar
to them. For those disabled elderly with
84 2009 Taiwan Public Health Report
rehabilitation needs and yet are unable to
be transported to medical care institutions
for rehabilitation, they are provided with
home or community rehabilitation services
to help maintain and improve their mental
and physical functions. To strengthen the
supporting systems for the caregivers,
to allow families in the long-term care of
cases a brief break, a respite care service
is offered to the home-care givers.
(2) To improve care of the dementia elderly,
the Department has, since 2005,
subsidized 18 nursing homes to set up
356 beds for the care of the dementia
elderly, and to improve quality of services
and facilities, and thus to upgrade the care
capacity of these nursing homes for the
care of the dementia elderly, and to reduce,
at the same time, troubles encountered in
the care of patients, and to improve their
quality of life.
(3) Local competent health authorities have
designated 240 medical institutions
to conduct assessment of mental and
physical impairment. The Mentally and
Physically Impaired Persons Rights
Protection Act was promulgated on July
11, 2007. Assessment standards will be
formulated in accordance with the ICF
system of the World Health Organization
in eight categories of mental and physical
impairment. On May 28, 2008, the
Department commissioned out this task to
the Corporate De-Zhe Medical Research
Foundation.
2) Oral Health Prevention and Control Act”was
promulgated to effectively regulate the
The common problems of oral health of the
control of HIV infection and to protect the
mentally and physically impaired are lack of
rights of the infected. To meet the needs
medical care restoration, poor oral hygiene,
of the changes in diseases epidemics, and
inadequate tooth-cleansing, and lack of preventive
also in accordance with the more active
health intervention. For this, various activities
actions in the protection of human rights
have been promoted for the preventive care of
around the world, the Act was amended
oral health of the mentally and physically impaired.
and renamed the“HIV Infection Control
(1) The five-year plan for the oral health of
and Patient Rights Protection Act”, to
the mentally and physically impaired was
respond to the spirit of human rights and to
approved by the Executive Yuan on May
meet the demands of AIDS control.
26, 2008.
(2) The public understanding of AIDS is
(2) A project, oral preventive health care
significantly insufficient; many of them
service for the mentally and physically
hold discrimination and misunderstanding
impaired in 2008, was conducted to train
against the infected. The infected
dentists and oral health workers, and to
often face many unfair treatments in
provide oral preventive health care services
employment, schooling, medical care,
in 28 institutions for the mentally and
nursing care and placement. For this,
physically impaired. A project of fluoride
based on the HIV Infection Control and
application on teeth for the prevention of
Patient Rights Protection Act, two sets
dental caries for children is also conducted
of regulations, Regulations Governing
to reduce their dental caries rate.
Protection of the Rights of the HIV-Patients,
and Operational Directions for Reviewing
4. Human Rights Protection and Care of the
of of Applications for Stay or Residence
HIV-Infected
for HIV-Infected Individuals, have been
The Department has spared no efforts in the formulated to maintain the dignity and
human rights protection and health care of AIDS rights of the infected.
patients. Taiwan is one of the few countries that
2) Health Care
provide the HIV-infected with free medical care.
When HAART was first developed in 1997, it was (1) S i n c e t h e a m e n d m e n t o f t h e A I D S
immediately brought in to provide the infected with Prevention and Control Act (now the
free cocktail therapy. HIV Infection Control and Patient Rights
Protection Act) on February 5, 2005, free
1) In the Protection of Human Rights
anti-HIV medications have been provided,
(1) O n D e c e m b e r 1 7 , 1 9 9 0 , t h e “ A I D S and payment under the National Health

Health Care for the Less Privileged Groups 85

 Insurance has been extended to the
non-insured HIV-infected to improve the
coverage of medical care and accessibility
to medical care. In 2008, 12,061 patients
(4) Private sector organizations such as the
had been treated, at a rate of 83%.
(2) To improve the effects of medical care for
the HIV-infected, to encourage the HIV-
infected in the self-management of health,
a case-manager project for HIV infection
has been implemented since 2007. In
2008, 21 designated medical institutions for
(5) To enhance the counseling for the HIV-
HIV control were in this project to provide
cases with education and counseling.
(3) Through the follow-up management of
county/city health bureaus and case-
managers, patients are supervised to
visit regularly the designated hospitals
for treatment. They also care about
the cases, their conditions, and thus to
improve their willingness to medical care.
Promotional campaigns are conducted
on the advantages of regular medical
care to prolong their chances of survival,
reduce opportunistic infections, and thus
86 2009 Taiwan Public Health Report
to improve their quality of life. Counseling,
testing and follow-up of contacts are
enhanced.
Harmony Home Association, Taiwan, and
charity groups such as the Taiwan Roots
Association have been subsidized to assist
in the care of cases, making arrangement
for their medical care, and emergency
placement.
infected and health education of the
correction institutions , as well as to
improve the knowledge of the inmates
about HIV infection, three private sector
organizations were commissioned to
provide counseling and health education in
correction institutions in 2008, to improve
the knowledge of the inmates on HIV
infection. Through counseling, cases were
encouraged to accept medical care, and
thus to protect themselves others, and to
further reduce the HIV infection.
 National

8
Health 86︱Section 1 Current Status of
the National Health
Insurance Insurance

93︱Section 2 Reform of the

National Health
Insurance System
 8 National Health Insurance
Since its inception in March 1995, the National
Health Insurance (NHI) has greatly reduced the
financial barriers of the public to medical care.
The satisfaction rating of the public has always
stayed high at around 70-80%. Many countries
have praised this system. In the year 2008 alone,
409 persons from 36 countries made study visits.
This Chapter focuses on the current status of the
National Health Insurance and its reform.
Section 1 Current Status of
the National Health
Insurance
The National Health Insurance is one of the
most important social constructions of Taiwan.
The current status of the NHI is summarized as
follows.
1. Current Status of Insurance Enrollment
The National Health Insurance is a mandatory
social insurance. All individuals holding the
Republic of China nationality and have registered
their household in the Taiwan Area for more than
four months shall, by law, join the NHI. Aliens
holding certifying documents for residency and
have resided in Taiwan for more than four months
shall also, by law, join the NHI. However, persons
employed are not restricted by the preceding
four-month regulations. By the end of 2008, the
total enrollment (not including the armies) was
88 2009 Taiwan Public Health Report
22,918,144 persons, and the enrollment rate was
more than 99% of the population.
In 2008,, the various assistance measures
were continued to protect the rights to medical
care of the disadvantaged minorities and to their
burdens on insurance premiums. In addition
to those mentioned in Chapter 7, the following
assistance measures have also been actively
promoted.
1) Easing the Financial Burden of Those with
Catastrophic Illnesses
Patients suffering from cancer, chronic
psychiatric diseases, in hemodialysis, congenital
disorders and rare diseases are waived of their
partial payment of the medical costs. By the end
of 2008, around 790,000 patients carried valid
catastrophic illness certificates.
1) Assuring the Medical Rights and Drug Use of
Patients of Rare Diseases and Hemophilia
The NHI Medical Expenditure Negotiation
Committee has, since 2005, budgeted in the global
budget for hospitals special funds for the medical
costs of patients of rare diseases, hemophilia and
AIDS to protect their rights to medical care and
drug use.
2. Insurance Financing
When the NHI was initiated, the insurance
premium rate was set at 4.25%. Through all
efforts of the Bureau of National Health Insurance
in promoting various measures to broaden i) Drug price surveys and the 6th drug
sources of income and reduce expenditures, price adjustment have been conducted;
and by implementing strict financial monitoring, inspections of medical care institutions
the premium rate that was originally planned in violation of regulations and review
to maintain the financial stability for five years and reduction of medical costs have
had been continued without adjustment until been made to contain unnecessary
September 2002 when a slight adjustment was expenditures.
made to 4.55%. ii) Higher co-payment is collected to
In 2008, the insurance revenue was NT$ reduce abuse, and to monitor financial
402.001 billions, whereas the insurance costs expenditures for items of medical care
were NT$ 416.425 billions, giving a deficit of NT$ such as out-patient services, drugs and
14.424 billions by accrual basis. In the period rehabilitation of higher utilization.
between March 1995 and end of 2008, the total iii) On December 31, 2008, the Depart-
insurance revenue was NT$ 4,304.626, whereas ment called a national meeting on drug
the insurance costs were NT$ 4,331.621 billions, policies of medical and pharmaceutical
and the total deficits for these years had been NT$ groups, experts and scholars, and
26.995 billions. The annual cumulative balance representatives of consumers, to
of the safety reserve is lower than the one month discuss measures to reduce drug price
total of the insurance payments. differences. The two resolutions of

Along with the aging of population and the meeting are, (1) a mechanism will

increase in the medical expenditures for high- be adopted to timely adjust and reflect

technology medical care, medical expenditures market prices of drugs whose patent

of the NHI have increased year by year. For rights are overdue; and (2) drug price

economic reasons, the insurance premium rate surveys and adjustment will focus on

has not been adequately adjusted for many years. the short and medium periods after the

The Department and the Bureau of National patent rights are overdue.

Health Insurance have continued to actively (2) Income Increment

promote some reform plans, formulated several
Issuance of bills to the interrupted insured is
administrative measures, and promoted various
expedited; their insurance categories and amount
measures to increase sources of income and
of payment are checked. Each year, NT$ 1 billion
reduce expenditures and prevent waste in the use
from the balance of the public-interests lottery and
of medical resources, and thus to alleviate the
NT$ 18 billions from the health and welfare tax
financial difficulties of the NHI. These measures
levied on tobacco products are collected. Multiple
are as follows.
programs of micro-adjustment are implemented.
1) P r o m o t i n g t h e “ I n c o m e - I n c r e m e n t a n d
2) To realize equity in the sharing of insurance
Expenditure-Reduction Measures”to maintain
premiums and to adjust premiums in
financial stability including:
coordination with increase in basic wages,
(1) Containment of Medical Expenditures the Bureau of National Health Insurance

National Health Insurance 89

 announced on July 27, 2007, in accordance care resources”, and“the plan for
with the amended“categories of the insurance the treatment of chronic hepatitis B and
underwriting wages”, a set of notes on the C”are amended; a new plan for the
provisions of Article 70-1 of the Regulations care of metabolic syndrome is added.
Governing the Implementation of the National
ii) Increase in the payments for organ
Health Insurance Act. The preceding notes
transplantations to reflect the
were implemented on August 1, and the
relative resource input of surgical
minimum amount of insurance underwriting for
transplantation and to encourage organ
the insured under Group I of Category II was
transplantation.
made to be claimed by the 6th grade of the
iii) To improve care quality, a new practice
classification of the new insurance underwriting
to adjust upward by 20% of the out-
amount (NT$ 21,000). An additional income
patient diagnostic fee of outpatient
of NT$ 5.5 billions per year in insurance
services for children under two years of
premiums was made.
age (inclusive) is implemented.
3) The preceding measures though may have
iv) The high payment for hemodialysis is
helped the insurance financing, they are
discontinued. Payments are made in
not enough to make up the deficits. In the
accordance with the classification of
long run, the insurance premium rate should
diseases by severity; payments for the
be reviewed. Review of premium rate will
automatic peritodialysis are added.
be made through legal procedures at an
appropriate time following the progress of law v) In coordination with the balances after

amendment and financial needs. the adjustment of drug prices, service

fees for the outpatient services of
3. Insurance Benefits and Systems hospitals, diagnosis and treatment
fees for hospital care, pharmaceutical
1) Payment schedules for medical fees in the
service fees, general fees for hospital
National Health Insurance are reviewed and
care and bed costs of economic
amended to upgrade the quality of medical
hospital beds and nursing care
care and to assure reasonable payments.
fees, hospital care fees for chronic
Work done in 2008 include:
psychiatric patients and day hospital
(1) For Western Medicine
care, and drug costs of primary care
i) “The plan for the implementation institutions have been adjusted.
of reserved funds to assure the
vi) The plan to improve medical payment
total quality of western medicine
for tuberculosis of the National Health
primary care”,“the health care
Insurance is included in the payment
quality indicators”,“the pay-for-
schedules to extend the scope of care.
performance system”,“the family
(2) For Chinese Medicine
docters integrate care plan”,“the
plan to improve areas of less medical i) “The health care quality indicators”,

90 2009 Taiwan Public Health Report

 the“pilot project of Chinese medicine
aiding in the care of cerebrovascular
disease patients with bedsore under
hospital care of western medicine”,
the“pilot project on the out-patient
clinic care by Chinese medicine of
children with cerebral paralysis”,
the“pilot project on the care of child
asthma at respite period by Chinese
medicine out-patient care”, and“the
plan to improve areas of less medical
care resources”are amended.
ii) New items for the treatment of complex
trauma by Chinese are added to
upgrade the quality of care.
iii) Fees for prescribing oral medicine
after treatment by Chinese medicine,
trauma and dislocation replacement
are adjusted upward.
(3) For Dentistry
i) The plan for the implementation of
reserved funds to assure the total
quality of dental out-patient care, the
index items of medical care quality and
their monitoring values, the pilot project
on care service of total special service
items at dental out-patient clinics,
and the plan to improve areas of less
medical care resources are amended.
ii) Endodontics of permanent teeth,
specific local treatment, oral and
maxillofacial and neck malignant tumor
post-operation treatment, biopsy of soft
tissue during pre-cancer sections, and
biopsy of hard tissue during pre-cancer
sections.
2) To reasonably contain medical costs, the
budgeting mechanism has been practiced
universally since July 2002. Action has also
been taken to reform the payment schedules
and the review systems to move from case
review to the establishment of a document
analysis-oriented review of the overall medical
care patterns.
3) After the Executive Yuan has approved the
range of growth of the NHI global budget,
the matter is handed over to the NHI Medical
Expenditure Negotiation Committee to
coordinate the insurance payers and the
service providers to negotiate the global
budget and allocation of certain service items.
4) To improve the accessibility of the insured to
medical care, medical institutions in contract
with the Bureau of National Health Insurance
are all around the country. By the end of 2008,
there were 23,874 such institutions.
5) R e g u l a t i o n s g o v e r n i n g p a y m e n t o f
pharmaceuticals are adjusted one by one to
improve the quality of drugs used by the public
and to give them more choices of drugs, and
also to reduce their financial burdens.
4. Review of Medical Care and Disclosure of
Medical Care Quality Information
1) Review of Medical Care Services
(1) P r o c e d u r e r e v i e w a n d p r o f e s s i o n a l
review: Procedure review is to review the
accuracy of the information on the claims
submitted by medical institutions, and
to make sure that the claims meet the
various requirements of the fee schedule.
A computerized automatic review system
is set up to improve efficiency. In the
process of professional review, claims
are either randomly or purposely sampled
through computers; they are then reviewed
National Health Insurance 91
 professionally by the invited expert medical
personnel.
(2) In coordination with the fee schedules,
regulations governing payments for
pharmaceuticals, or consensus on
professional review of the branch bureaus
of the Bureau of National Health Insurance,
notes on the review of various disciplines
are studied and revised for reference of
physicians in the treatment of patients.
(3) Medical experts are invited to use the
data of claims for medical fees to develop
indexes of non-payment for drugs,
examinations, operations or medical
treatment. Abnormal cases are reviewed
by procedure review for deduction in
payment to correct abnormal medical
behavior. By the end of 2008, 44 non-
payment indexes had been announced.
(4) The review and administrative relief
of medical fees of the National Health
Insurance come in initial review, reply, re-
deliberation, dispute mediation, appeal
and administrative litigation. If the medical
care providers are in disagreement with
the results of the review on medical fees,
they may apply for re-deliberation, and
eventually dispute mediation if they are not
convinced of the results of re-deliberation.
Dispute mediation is handled by the NHI
Dispute Mediation Committee.
2) Disclosing Information on Quality of Medical
Care
Through disclosure of the quality indicators of
the professional medical care services provided
by medical care institutions, people will have
direct access to the results of quality monitoring of
various medical care institutions. They can then
92 2009 Taiwan Public Health Report
substantially supervise the quality of medical care.
Quality information by hospitals and
departments is published on the Internet for public
inquiries. By the end of 2008, 63 indicators had
been announced for inquires by 2,098,222 person-
times.
5. NHI IC Card
To reform the NHI certification, the NHI IC
card has been universally used since January
2004 to provide the public with a simple, more
convenient and safe service. The name-card
size NHI IC card contains four information storing
sectors for personal information, health insurance
data, special zone for medical care, and health
administration special zone. The IC card can also
provide timely information on medical care; it also
contributes to disease control. Achievements in
2008 are as follows.
(1) 99.9% of all NHI contracted medical care
institutions have been verified for linking
to provide a platform for communication
between institutions.
(2) A special project to supervise the insured
of abnormal utilization of medical care in
clinics under the National Health Insurance
is conducted. In 2008, a total of 15,128
patients had visited clinics for more than 20
times each month. After supervision, the
number of visits had declined by 40-60%.
(3) “Organ donation”is noted on the NHI
IC Card. Thus far, 67,801 persons have
registered. This would allow medical
personnel to know at the first moment
about the individual's willingness of organ
donation. In addition, 20,342 persons
have registered for“hospice and palliative
care”. Hospice and palliative care will be
 provided to terminal patients in respecting
their wishes to die with dignity and in
peace.
(4) Since July 2005, immunization is registered
on the IC card. During the period from
2006 to 2008, 7,146,651 pieces of
information had been registered.
the uploading of the IC card information,
medical care records of persons traveling
from Southeast Asia countries is made
available to facilitate the necessary
management of dengue fever control.
Section 2 Reform of the
National Health
Insurance System
After several years of planning, the NHI
Second-Generation Planning Task Force of the
Executive Yuan has submitted a final report. The
amendment of laws for the second-generation NHI
is actively planned.
1. Goals of reform: to assure the reliability of
medical care.
2. The core values: quality, equity, efficiency.
3. Key issues of law amendment:
1) O r g a n i z a t i o n a l s t r u c t u r e a n d s o c i a l
participation: The NHI Supervisory Committee
and the NHI Medical Expenditure Negotiation
Committee will be merged into the NHI
Supervisory Council to unify responsibilities
of insurance revenue and expenditures, to
strengthen the linking mechanism of the NHI
financial revenue and expenditures, and to
conduct relevant social participation of the
citizens before major matters of the insurance
are decided.
2) New premium system: Funds needed for the
insurance will be shared by the government,
the employers and the insured. Shares of
the government will be calculated by certain
formula of growth rate; shares of the employers
will be calculated by certain formula and linked
to the contributions of the insured; and shares
By
of the insured will be calculated on household
incomes.
3) Medical care quality and information disclosure:
It is clearly stipulated that information on
medical care quality relevant to the National
Health Insurance be publicized periodically;
and the pay for performance system be
strengthened. Ways and procedures to
formulate items of payments and payment
schedules for medical care services and
pharmaceuticals will be established.
4) Others: To prevent those who have stayed
abroad for some long time from taking
advantage of the insurance for medical
care, regulations governing the immediate
insurance underwriting of those who have
record of insurance underwriting in past are
deleted. A difference sharing system is set
up. The insured may decide to use expensive
medicines, the cost of which exceeds the upper
limit of payment, and pay the differences.
4. Progress in Law Amendment
The draft amendment of the National Health
Insurance Act was once again submitted to the
Executive Yuan for review on January 25, 2008;
and to the Legislative Yuan for review on February
15, 2008. The first reading of the Legislative
Yuan was completed on February 29, 2008. The
draft is currently under the review of the Health,
Environment and Labor Committee.
National Health Insurance 93
 International 95︱Section 1 Joining the World

9
Cooperation Health Organization

96︱Section 2 International
in Health Exchange and
Cooperation in
Health

100︱Section 3 International Medical

Aid
 9 International Cooperation in Health
The promotion of international health affairs
is not only a matter of world trend, it is also
essential in developing an international stage for
healthcare management. Therefore, in addition to
international cooperation and exchange, planning,
promotion and coordination of policies concerning
international aid, the collection of information,
participation in international organizations,
enhancement of international image, recruitment
of specialists, and manpower development for
international health should be in line with global
trends - to develop diversity in the international
health cooperation models in order to attain the
ultimate goal of feeding back and contributing to
world health. In May 2009, after years of efforts,
Taiwan, at the invitation of the Secretary General
of the World Health Organization, attended the
World Health Assembly in the capacity of an
observer.
Section 1 Joining the World
Health Organization
Efforts to join the World Health Organization
began in 1997. Throughout the years, Taiwan
has upheld the principle of“diseases see no
boundary”, through professional appeals, and
also for the health rights of the 23 million people
on Taiwan, in the efforts to join the WHO. For
years, by the support of allied countries and
international friends, the international community
has gradually come to realize the necessity of
Taiwan in joining the WHO; many countries and
major international health organizations have
openly supported Taiwan's appeal of joining the
WHO.
1. In the last 12 years, Taiwan has strived to
join the WHO. During this period, Taiwan
experienced the outbreak of SARS and
enterovirus, which made the international
community to realize once again the
importance of cross-border cooperation in
disease control and health care; and at the
same time, the importance of Taiwan becoming
a member of the WHO. Taiwan will continue
to actively participate in various international
health-related meetings and activities to fulfill
the responsibility as being a member of the
global village, and thus to gain the support and
recognition of other countries.
2. In 2008, Taiwan continued to take part in
various WHO-associated conferences and
activities, activities of major international health
organizations, and cooperation in international
health affairs. Major achievements are as
follows.
1) Former US Secretary of Health and Human
Resources, Mr Tommy Thompson, visited
Taiwan in April 2008. On many occasions,
International Cooperation in Health 95
 Mr Thompson has openly expressed his
support to Taiwan's appeal for joining the
WHO.
2) Former Minister of Health, Dr. Hou Sheng-
mou, sent a letter to the Secretary General
of the WHO, to each health minister of
the 193 member states of the WHO, and
presidents of four major NGOs, to solicit
their support to Taiwan's appeal.
3) A bilateral meeting with Mr Michael Leavitt,
US Secretary of Health and Human
Resources was held. Mr Leavitt also wrote
a letter on behalf of Taiwan to the WHO
Secretary General for support to Taiwan's
appeal.
4) Exchanges were made on health issues
with 17 allied countries of Taiwan. In these
exchanges, Dr. Hou, former Minister of
Health, on behalf of the 23 million people
on Taiwan, expressed the gratitude to them
for their support to Taiwan joining the WHO.
5) I n D e c e m b e r 2 0 0 8 , P r o f e s s o r K a n g
Chao-chou, professor of toxicology of the
National Taiwan University, at the invitation
of the Department, participated in the
WHO-sponsored conference of experts on
toxicology of melamine held in Canada.
At the conference, Dr. Kang presented
Taiwan's findings on the melamine testing
for discussion.
In the early stage of promotion, the WHO
was non-responsive to Taiwan's request; major
countries such as the US, Japan and the EU were
not so enthusiastic t as well. However, in recent
96 2009 Taiwan Public Health Report
years, the US and Japan have publicly supported
Taiwan to become an observer of the WHA; and
the European countries have also supported
Taiwan's participation. Many other countries
have also turned from their previous indifference
to willing to support Taiwan's participation in the
WHO. Especially in 2008, several allied countries
spoke strongly at the WHA to support Taiwan's
appeal and won approval from many countries
present. This kind of development is favorable to
Taiwan's appeal, and should lay the foundation for
Taiwan's eventual membership.
Section 2 International
Exchange and
Cooperation in Health
International organizations such as APEC (in
Asia), PAHO (Pan American Health Organization
in the Americas), WAHO (Western Africa Health
Organization in Africa), and EHFG (European
Health Forum Gastein) and OECD (in Europe) are
fully utilized to appeal to the international media
Taiwan's humanitarian medical aid programs
and substantial exchanges in medical care with
other countries, and thus to improve Taiwan's
international visibility. Activities of international
exchange and cooperation in 2008 are as follows.
1. Participation in and Holding of International
Conferences and Symposiums
1) International Conferences
(1) In April 2008, a delegation was sent to
participate in the Dubai International
Humanitarian Aid and Reconstruction
 Conference and Exhibit. In the exhibit,
Taiwan's contributions in humanitarian aid
were displayed.
(2) In October, the Department collaborated
with the International Forum Gastein, to
organize the 11th European Health Forum
Gastein in Austria. A parallel forum was
hosted by Taiwan on the issue of“Health
E t h i c s ” t o s h a r e Ta i w a n ' s h e a l t h
experience with European countries and
improve our international exposure.
(3) In October, the Workshop on Public Health:
International Trade and Domestic Legal
Issues, was held to discuss the issues,
such as“WTO and the development of
public health”,“drug use in developing
countries”,“food safety”, and“tobacco
control and trade disputes”.
(4) In October, a delegation took part in
the APHA (American Public Health
Association”annual meeting. Dr. Yeh
Chin-chuan, former Minister of Health,
was invited to give an opening speech
and present the achievements of the
National Health Insurance in Taiwan. His
speech and presentation received standing
ovations. At the same time, two parallel
forums on Taiwan's achievements in public
health were also held, and ten papers
were presented at these forums to share
Taiwan's experience with others.
(5) In November, the 2008 Global Forum for
Health Leaders was held. The theme of
the Forum was“Health and Globalization:
Challenges and Opportunities”to focus on
issues such as“Evidence-Based Health
Policy”,“Global Trend of Healthcare
Policy”, and“Capacity-Building for
Disease Control”. Some 260 participants
from 32 countries took part in this Forum.
(6) I n N o v e m b e r, t h e 4 0 t h A s i a - P a c i f i c
Academic Consortium of Public Health
International Cooperation in Health 97
 (APACPH) was held in Kuala Lumpur,
Malaysia. Dr. Chiu Wen-ta, President of
the Consortium, was honored to give the
opening speech, which demonstrates.
importance of Taiwan in the promotion of
public health in the Asia-Pacific countries.
2) Symposiums
(1) In March, the TaiwanIHA held an exhibit
of its two-year achievements in medical
aid and a symposium on“sustained
development of humanitarian aid from the
global viewpoint”.
(2) In September, there was an outbreak
of melamine contamination in food from
China. To synchronize the management of
food safety in Taiwan with the international
community, an International Experts
Meeting on the Control of Melamine-
Contaminated Food was held. Experts
from the US, Japan, Australia, New
Zealand and the EU were invited to discuss
strategies to face these problems.
(3) To p r o m o t e i n t e r n a t i o n a l e x c h a n g e
on Chinese medicine and pharmacy,
the following symposiums have been
held:“23rd Symposium on Natural
Products”,“2008 Perspective
B i o m e d - Te c h n o l o g y D e v e l o p m e n t
and 7th Cross-Strait Medicine and
Biology Conference”,“The 7th
Consortium for Globalization of Chinese
Medicine”,“2008 International
Symposium on Chinese Medicine”,“2008
Cross-Strait Symposium on Chinese
Medicine and Pharmacy”, and“2008
98 2009 Taiwan Public Health Report
CAM/TM professional training program”.
3) Consultation Meeting: On October 21, 2008,
Taiwan participated in the 20th Taiwan-
EU Consultation Meeting held in Brussels.
At the meeting, Taiwan presented several
health issues such as the establishment of a
collaborative mechanism for the quick reporting
of unqualified food between Taiwan and the
EU, and the control of counterfeit drugs.
Discussion was also held with officials of the
EU.
2. Exchange and Cooperation
1) In the APEC Health Task Group, the feasibility
of combining the APEC electronic medical
record and the APEC tourism card was
proposed. The importance of the international
transmission of communicable diseases and
their collaborative control was also stressed.
The APEC Health Task Group website is
maintained to provide each economic entity
with information on health, safety and activities
to strengthen Taiwan's participation in APEC.
2) The DOH-Taoyuan Hospital was commissioned
to conduct the 2008 health cooperation plan
with the Belize sister hospitals and the Central
and South Americas, to continue to promote
bilateral and multilateral cooperation and
exchange with the Central and South American
health organizations. The DOH-Taichung
Hospital was commissioned to conduct the
2008 health cooperation plan in the West
African region, to help medical personnel of
Gambia and Ghana for training in Taiwan and
also promote matters on cooperation and
exchange in health affairs.
3) The Italy-Taiwan Association was subsidized to
conduct a series of activities in memory of the
fifth anniversary of the death of Dr. Obani.
4) A m e m o r a n d u m o f u n d e r s t a n d i n g o n
cooperation was signed with the Marshall
Islands. The Taiwan Health Center was set up
in the Majuro Hospital of the Marshall Islands.
Cooperation in health affairs with the Marshall
Islands is promoted.
5) Five projects under the Taiwan-Japan Technical
Exchange Program and two projects under the
Taiwan-Japan Technical Cooperation Program
have been conducted.
6) The National Cheng-kung University was
commissioned to conduct the 2008 Kenya
Medical Cooperation Program to collaborate
with the Great Lake University Kisumu to hold
training on disaster prevention and response
to help participants develop their capacity in
responding to disasters.
7) In April, a Taiwan-France symposium on
Chinese herbal medicines was held. At the
meeting, Taiwan's experience in including
Chinese herbal medicine in the payment of
the National Health Insurance and its current
development were explained. This paved way
for future cooperation between the two sides.
8) In December, visits were made to the health-
related organizations of the OECD to
understand their operational mechanisms on
health matters.
3. Education and Training
1) The Central American Medical Personnel
Training Center of Panama invited Taiwan's
experts in influenza control for lectures.
The lectures were well received and highly
acknowledged by all.
2) A project of“Legal advice on trade and public
health, and manpower training on dealing with
international affair”was organized to promote
the capabilities of the staff of the Department
International Cooperation in Health 99
 in the undestanding of international trade laws
and public health counseling on relevant legal
issues was also offered.
3) The Taiwan Health Center in Marshall Islands
conducted training programs such as CPR and
disaster rescue, health education on oral health
for school children, screening of diabetes for
prevention and health promotion, cooking
classes and preventive screening, training
of nursing personnel from the Asia-Pacific
region, and training of medical personnel from
neighboring countries.
4) At the Taiwan Health Center in the Solomon
Islands, training on the control of tuberculosis
was held. Students were given health
education in the promotion of oral health.
Health examinations were offered to local
residents.
5) The DOH-Taipei Hospital was commissioned to
set up the Taiwan International Medical Training
Center for health and medical personnel. In
accordance with the medical diplomacy policy
of the government, the Center is to promote
Taiwan's international health. The Center
has thus far trained medical personnel from
Mongolia, Russia, Indonesia and Burkina Faso,
and established a collaborative mechanism
for Taiwan in international exchange and
cooperation in health affairs.
Section 3 International Medical
Aid
Facing the new challenges of globalization
and where diseases see no borders, Taiwan
100 2009 Taiwan Public Health Report
has spared no efforts in promoting international
cooperation in health and medical aid to knock
at the doors of the international community, and
to promote deeper understanding of Taiwan and
its people, hoping to gradually promote Taiwan's
health diplomacy. Major achievements in 2008
are as follows.
1. Medical Aid
1) In March when Ecuador was heavily flooded,
the TaiwanIHA immediately dispatched a
medical team to provide medical care services.
Sets of disaster rescue devices were procured
to help in the rescue and relief of the disaster.
2) In May when Myanmar was hit by a tropical
storm, the TaiwanIHA, the Lin-Jiou Mountain
Buddhist Foundation and the ROC Rescue
Association joined together to dispatch
medical teams with medicines and supplies for
emergency rescue and to provide medical care
services.
2. Medical Assistance
1) The National Taiwan University Hospital was
commissioned to conduct a Global Medical
Instrument Support and Service Program.
A total of 37 medical care institutions and
medical device dealers have donated 165
pieces of medical devices for the benefit of
eight countries.
2) In collaboration with the Ministry of Foreign
A ff a i r s , i n f r a r e d - r a y b o d y t e m p e r a t u r e
screeners were donated to the airport of El
Salvador. A signing ceremony was held at the
ROC Embassy in Salvador.
 102︱Section 1 Projects Promoted
Science and with Priority

10
Technology 103︱Section 2 General Science
and Technology
Research Projects
Research
106︱Section 3 National Science
and Technology
Research Programs

106︱Section 4 Research Projects

of the National
Health Research
Institutes
 10 Science and Technology Research

The Department focuses on“science, Section 1 Projects Promoted

technology and welfare”as its goal of science
with Priority
and technology development and formulates
relevant policies by evidence-based research to 1. The BioMedTech Island Program –
promote national health and medical care. Establishment of an Excellent Clinical Trial

In 2008, the total amount of budget in science and Research System

and technology research was NT$ 4.709 billions,
an increase of 7% over 2007 (Figure 10-1). The
type of research programs include“projects
promoted with priority”,“general science and
technology research projects”, and“national
science and technology research programs”.
1) A national excellent clinical trial and research
center is set up in the National Taiwan
University Hospital. The Chengkung University
Hospital, National Defense Medical Center
and the Wanfang Hospital have set up local/
regional specific excellent clinical trial and

Figure 10-1 Allocation of Funds for Science and Technology Research

NT$ billion National science and General science and technology Projects promoted with
technology research programs research projects priority
35
31.67

30 29.32 28.90
27.90
26.59

25

20

15

10.37
10
7.8 7.82
6.84
5.99 5.72
4.87 4.8
5

0
2004 2005 2006 2007 2008 Year

102 2009 Taiwan Public Health Report

 research centers of tumor, cancer, stroke and
trauma to improve care of patients.
2) In 2008, physicians, pharmacists, nursing
personnel and clinical trial statisticians
participated in clinical trial research to improve
the quality of the clinical research-related
professionals .
2. The BioMedTech Island Program –
Preparatory Phase of the Taiwan Bio-Bank
Project
Public hearing on the draft of Taiwan BioBank
Management Act was held on August 15, 2008.
The draft was submitted to the Executive Yuan for
review on November 28 for further review.
3. Development (including mass production
techniques) of Vaccines for Human Use
Four vaccines, H5N1 influenza, enterovirus
71, cellular Japanese encephalitis and Group B
meningococcal, have been developed. In 2008,
the potency testing and the pre-clinical toxicology
testing of rodents and non-rodents of influenza
vaccine cell-bank and virus-bank had been
completed.
4. Pilot Project on the Use of RFID in Health
and Medical Care
For patient identification, care procedures,
drug safety and management of expensive
medical instruments, the DOH-Taichung Hospital
has used the Radio Frequency Identification
(RFID) system for management and auditing. The
patient identification rate has reached 100%. An
automatic recording of drug use and functions to
detect errors in patient identification have also
been set up to serve as indicators of reporting in
patient wards.
5. Tuberculosis Control Integrated Project
A diagnosis chip for the rapid testing
of tuberculosis bacilli directly from sputum
specimens has been developed for more sensitive
and specific testing of active tuberculosis bacilli.
The technique is used as a screening tool to help
physicians in clinical diagnosis.
6. Chronic Kidney Disease Control
A chronic kidney disease shared care network
website has been established to help medical
care institutions establish case information and
regularly remind caregivers to follow-up and
manage patients. By the end of 2008, 146 medical
care institutions used this system to manage
information for 36,399 patients. A system was
preliminarily established to promote the integrated
care of patients of chronic kidney diseases in both
primary care units and specialty hospitals. The
follow-up management and monitoring network
is shown in Figure 10-2. This is to improve the
integrity of health management of the high-risk
chronic kidney disease patients, and thus to
effectively reduce the incidence of terminal kidney
diseases.
Section 2 General Science and
Technology Research
Projects
1. Science and Technology Development and
Management Projects
To enhance administrative efficiency, the
DOH Information System for Solicitation, Review
Science and Technology Research 103
 Figure 10-2 National Chronic Kidney Disease Control and Care Model
Secondary care
Chang-gun
memorial
Hospital-Ke
elung
division
Primary care
Primary
(health examinations for adults and the elderly)
and Management of Science and Technology
Research Projects was set up and inaugurated in
July 2008.
2. Projects on Science and Technology
Research Policies in Health
1) Domestic and international public information
on medical care quality is collected and
analyzed. Surveys of the needs of the public
are completed. 50 sets of medical care
information are planned with priority. Web
systems and databases are developed and set
up. A mechanism and model for the publication
104 2009 Taiwan Public Health Report
Executive Center
Changhua Kaohsiung
Chengkung
NTUH Christian Medical U
U Hospital
Hospital Hospital
Region and District
Primary Care Units
Chronic Kidney Disease Patients
Local Health Bureaus/Health Stations
and transparency of information on medical
care quality is established.
2) The effects of mild and moderate dementia
patients and their families under home care
in community who are willing to accept
assistance are explored. It developed two
different intervention models, the“home-care
training”and the“family support groups”.
The result shows that the two intervention
models can equally reduce the workload of
families in the care of patients. Information on
their general health conditions and knowledge
and attitudes about diseases is also collected
 for reference in the planning of long-term care
policies.
3) In 2007-2008, visits and supervision of human
trial committees were made. 27 human trial
committees had passed the inspection and 26
committees had been supervised. Workshops
have also been held to upgrade the quality of
clinical trials.
3. Projects on the Science and Technology
Research Policies in Pharmaceuticals
1) The drug interaction database is updated
constantly to provide 24,300 medical care
institutions and pharmacies throughout the
country with relevant information to improve
drug safety.
2) In 2008, three national patent rights for
techniques in the research of Chinese
m e d i c i n e a n d p h a r m a c y, “ m e t h o d f o r
removing organic contaminants from Chinese
herbal medicines”,“a bio-medical system
with the wireless transmission and the pulse
diagnosis by the optical moire measurement”,
and“tongue diagnosis systems and
methods”, had been issued.
3) To u n d e r s t a n d t h e e f f e c t s o f C h i n e s e
medicine and pharmacy on gene expression,
a project,“The Genomic and Proteomics
Related Research on Traditional Chinese
Medicine”, is conducted. A compound herbal
prescription“ZC008”for treatment of liver
fibrosis has obtained US patent rights. In
addition, the result of the project,“evaluation
of anti-leukemia activities of Chinese herbs by
beta-catenin reporter gene”, has filed for the
ROC patent.
4. Projects on the Science and Technology
Research Policies in Food Safety and
Laboratory Testing
1) The study to analyze the levels of trans fatty
acids in fat, baking products, eggs and milk
products in EU and USA was performed. The
data will be available to the public and the
manufacturers.
2) Studies on methods to assess the health
promotion functions for eight health food
items such as, improvement of menstrual
pain, protection of kidney functions, reducing
occurrence of diabetes-induced cardiovascular
disorders, anti metabolic syndromes, alleviating
t h e f o r m a t i o n o f f a t t y l i v e r, h a v e b e e n
completed for reference in the formulation of
items and methods for the assessment of the
safety of health food.
3) Surveys of the food intakes and nutrition
statuses of pregnant women in Taiwan were
conducted in 2008. Studies show that women
in the early stage of pregnancy are generally
short of folic acid; they are deficient in iron,
calcium and multi-vitamins during pregnancy.
Their chances of exposing to second-hand
smoking are relatively high, which may lead
to direct and long-term negative impact on the
health of the pregnant women and fetuses.
Study results will be used for reference in the
formulation of nutrition promotion plans and
regulatory guidelines.
5. Project for the Establishment of a
Traceability System for Processed Food
Traceability networks for fresh milk on market,
packaged drinking water, flavored milk, yogurt,
Science and Technology Research 105
 and non-alcoholic beverage (coffee and tea) have
been established. The public can access to all
the information about production and sales from
the DOH food traceability website (http://tfts.firdi.
org.tw). Industries of dairy products, beverage
and packaged drinking water have been surveyed
and assessed, and assessed the requirement to
practice HACCP (Hazard Analysis and Critical
Control Points) and relevant activities.
6. Establishing A Health Technology
Assessment System
Four standard operational procedures for
the health technology assessment system have
been completed. Six research reports on the
assessment of reimbursement for drugs including
anti-lipid and osteoporosis have been completed.
T h e e x e c u t i n g b o d y, t h e C e n t e r f o r D r u g
Evaluation, has become the first in Asia a member
of the International Network of Agencies for Health
Technology Assessment (INAHTA).
Section 3 National Science and
Technology Research
Programs
1. National Research Program for Genomic
Medicine
1) Using the epidermal growth factor receptor as
a target, the high-speed method for screening
lung cancer drugs has been developed and
filed for the provisional patent of the US in
2008.
2) Two research teams,“on the study of anti-
liver cancer Chinese herbal medicine”,
and“on the genomic study of Chinese medical
106 2009 Taiwan Public Health Report
syndrome and sepsis”, have been integrated.
2. National Science and Technology Programs
for Agricultural Biotechnology –Project for
the Establishment of an Environment for
the Safety Assessment of the Genetically
Modified Food
The standard of procedures on the safety
assessment of genetically-modified food was set
up in 2008. Toxicological evaluation of viral genes
of PRSV and PLDMV in genetically-modified
papaya has been completed. Safety assessment
of the edible genetically-modified papaya has also
been performed and will serve as an important
reference for pre-marketing approval.
3. National Science and Technology Programs
for Biotechnology and Pharmaceuticals-
Promotion of Clinical Trial and Translation
Medicine
1) In 2008, 11 clinical trial projects had been
funded. Through monitoring and auditing,
clinical physicians and researchers enhance
their ability of GCP, and problems can be
identified earlier to strengthen the quality of
clinical trials.
2) I n 2 0 0 8 , t h r e e p a t e n t r i g h t s h a d b e e n
obtained for the studies of“cancer screening
method”(ROC patent rights), and“measuring
gastronintestinal parameters“ (Canada and
Singapore patent rights).
Section 4 Research Projects of
the National Health
Research Institutes
In coordination with the Department of Health
(DOH), NHRI conducts research on health care
systems, biomedical technology, pharmaceuticals,
biologics, and medical engineering. NHRI also
offers resources and services on biomedical
3) M o l e c u l a r d i s s e c t i o n o f E N O 1 - i n d u c e d
research, promotes research communication
and cooperation, and provides policy
recommendations. Major achievements of 2008
are as follows.
1. Cancer Research
1) Study on the mechanism of the modulation
of DNA repair enzyme O6-methylguanine
DNA methyltransferase in human cancer
cells: The results were published in Molecular
Pharmacology in 2008. The findings not only
4) The Taiwan Cooperative Oncology Group
provide a rationale for clinical trials with CPT
and BCNU combination treatment in human
cancers, but also suggest a new indication for
treating patients who are receiving refractory
CPT derivatives with BCNU.
2) Mobilization of bone marrow stem cells and
cancer cells by granulocyte colony-stimulating
factor in cancer therapy: The research
revealed that administration of G-CSF during
radiation neither promotes local tumor growth
nor aggravates distant metastasis.
immunosuppression in cancer patients:
Findings were that (1) knockdown of the
expressions of α-enolase (ENO1) tumor-
associated antigen and urokinase-type
plasminogen activator (uPA) genes could
result in loss of the cell invasion and tissue
metastatic capabilities of those cells and that
(2) administration of ENO1 antigen alone
into animals is sufficient to modulate the anti-
cancer immunity of the animals.
(TCOG): The group (1) held the Asia-Pacific
Congress on Oral Cavity Cancer in conjunction
with the 12th TCOG Annual Meeting,
December 6–7, 2008; (2) organized six clinical
research training courses for physicians,
nurses, and statisticians in 2008; and (3)
initiated and conducted the annual cancer
program accreditation for hospitals in 2008 with
Science and Technology Research 107
 the Bureau of Health Promotion, the results will
be included as one of the task indicators in the
annual performance evaluation.
2. New Drug Development
1) A n t i - c a n c e r d r u g d e v e l o p m e n t : R e c e n t
progress on two anti-cancer drug candidates,
DBPR104 and DBPR204, includes (1)
accomplishment of preclinical studies
with potentiality in treatment of various
malignancies; (2) grant of U.S. patents; and (3)
licensing out to SynCore Biotechnology Co. for
further preclinical and clinical development.
2) Anti-virus drug development: A recent study
focused on anti-HCV drug discovery and
development, and identified a potent oral
lead compound. This led to the signing of a
trilateral collaborative research agreement with
Genelabs Technologies Inc. and Genovate
Biotechnbology Co. in July 2008 to jointly
conduct further research to discover and
develop novel drug candidates targeting the
hepatitis C virus.
3) Anti-metabolic disease development: Recent
research has focused mainly on DBPR108,
a selected anti-diabetes drug candidate.
Notable achievements in this area include that
(1) DBPR108 was found to cause fewer side
effects than present drugs and to show good
in vivo efficacy in pharmacokinetic studies
as well as in reduction of blood glucose;
(2) a collaborative partnership for further
development began in 2008; (3) preclinical
studies have been launched; and (4) for
rational drug design of anti-obesity agents
targeting CB1 receptor, a series of compounds
have found to exhibit significant weight-loss
108 2009 Taiwan Public Health Report
efficacy; relevant patents have been filed.
3. Molecular and Genomic Medicine Research
1) The regulatory role of atypical dual-specificity
phosphatase (DUSP) in epidermal growth
factor receptor (EGFR) signaling: The results
indicate that an atypical DUSP VHR (VH1-
related) is involved in the regulation of EGFR
and focal adhesion kinase (FAK) signaling;
VHR's expression affects the growth and
migration ability of lung cancer cells.
2) D e v e l o p m e n t o f c o m p a r a t i v e a n a l y s i s
techniques for microbial pathogens: The team
has established standard protocols for Illumina
Genometyping, Roshe454 resequencing, and
NimbleGen comparative genomic hybridization
(CGH) platforms; the team also accomplished
c o m p l e te g e n o m i c s e q u e n c i n g o f th r e e
clinically important pathogens: Klebsiella
pneumoniae, Acinetobacter baumannii, and
Mycobacterium tuberculosis.
4. Research on Infectious Diseases
1) S i g n a l Tr a n s d u c t i o n P a t h w a y s o f D r u g
Resistance and Pathogenesis in Candida
albicans: Overexpression of CDR1, an efflux
pump, was previously found to be a major
mechanism contributing to the drug resistance
of Candida albicans, the most common human
fungal pathogen; the team recently discovered
that the expression of CDR1 is activated by a
transcription factor, CaNdt80p, and repressed
by serum; the team found that the cph1/cph1
efg1/efg1 mutant partially protects mice from
systemic infections by the lethal wild-type C.
albicans cells; the results demonstrate a new
approach for vaccine development.
2) Investigation of the mechanisms of innate
immune function defects in diabetes mellitus
patients: DMTB patients had more severe
infections, a higher mycobacterial load,
a higher treatment-failure rate, and more
delayed clearance of mycobacteria than TB
patients; these unfavorable characteristics
have led to a higher MDR-TB incidence in
DMTB patients who have undergone regular
anti-TB treatment; the team further found that
diabetes (both type I and type II) seemed to
decrease the phagocyte-derived cytokines,
while type II diabetes more severely affected
NK/T cells produced cytokines; these novel
findings suggest that hyperglycemia and insulin
resistance may affect immune reaction through
distinct and hence additive mechanisms.
3) The role of HBV pre-S mutants in pathogenesis
of HBV-related hepatocellular carcinoma:
The team recently used HBV pre-S1 and
pre-S2 mutants transgenic mice model in an
in vitro trial; the results demonstrated that the
potential chemopreventive agents containing
PPARs agonists and anti-oxidants (resveratrol)
can cause apoptosis of pre-S mutant
heptocarcinoma cell lines; this could possibly
be developed into a chemical prevention
treatment for patients of hepatocarcinogenesis
and chronic hepatitis B.
5. Bioinformatic and Genetics Research
Progression evaluation and cardiovascular
outcomes of hypertensive families — a follow-up
genetic study of the Taiwan SAPPHIRe cohort:
The team conducted variance component linkage
scans of 1365 non-diabetic Chinese subjects from
the Stanford Asia-Pacific Program of Hypertension
and Insulin Resistance (SAPPHIRe) study to
search for QTLs responsible for obesity-related
traits; several QTLs with strong linkage evidence
were identified after incorporating genotype by
sex (GxS) interactions into the linkage mapping,
including two QTLs for BMI on chromosome 12q
with MLS 3.37 (empirical p = 0.0043) and one QTL
for hip circumference (MLS = 4.22, empirical p =
0.000033); sex-specific analyses demonstrated
that these linkage signals all resulted from
females rather than males; all of the regions with
linkage signals were observed in one gender, but
not in the whole sample, suggesting the genetic
architecture of obesity-related traits does differ by
gender; the team also discovered a family-based
association of genetic variants in the IGF1 gene
in relation to anthropometric variables, glucose
levels, and insulin levels, based on a large sibship
data set collected from the SAPPHIRe cohort.
6. Environmental Pollution and Occupational
Medicine Research
1) Study on the biologically effective dose of
biomarkers induced by toxins of second-hand
cigarette smoking and occupational exposure:
The team developed a liquid chromatography/
tandem mass spectrometry (LC/MS/MS)
method for quantifying urinary cotinine as an
exposure biomarker for second-hand cigarette
smoking; the team also developed methods
for analyzing DNA adducts such as 8-OHdG,
7-MG, 7-EG, and 7-HEG, which are the
foremost methods internationally.
2) Study on the mechanisms of synergism in lung
cancer between arsenic exposure and cigarette
smoking: The team found that arsenic would
act specifically on p53-compromised cells
Science and Technology Research 109
 (p53 dysfunction or inhibition) and increase
carcinogenic risk due to the inhibition of
Gadd45a protein, which induces centrosomal
abnormality and colony formation; the team
also found that NNK could provide a p53-
compromised status, triggering synergism
of arsenic and NNK; the results imply a
carcinogenic risk from second-hand smoking
and even from low dose arsenic exposure via
food or drinking water.
3) T h e c o n t r i b u t i o n o f a i r p o l l u t i o n t o
cardiovascular diseases in Taiwan: The results
suggest that deaths from lung cancer and
cardiopulmonary diseases could be reduced
over a 10-year span, given the following limits
on atmospheric PM2.5: if the limit is set at
20μg/m3, 9,807 deaths from lung cancer and
38,967 deaths from cardiopulmonary disease
3) Interventional MRI (iMRI) research program:
could be avoided; if it is set at 15μg/m3,
12,817 deaths from lung cancer and 51,549
deaths from cardiopulmonary diseases could
be avoided; and if it is set at 12μg/m3, 14,464
deaths from lung cancer and 58,640 deaths
from cardiopulmonary diseases could be
avoided.
7. Medical Engineering
1) I n v e s t i g a t i o n o f t h e f e a s i b i l i t y o f “ c e l l
enhancement”by cultured human & rabbit
corneal endothelial cells on a biodegradable
membrane to improve the quality of cornea
donors: the study demonstrated a novel
technique to transplant cultivated HCECs as
a cell sheet directly onto rabbit corneas and
a promising recovery of corneal clarification;
the team also developed a novel strategy
for corneal endothelial reconstruction with
110 2009 Taiwan Public Health Report
a bioengineered cell sheet that cultivated
human CE cells by temperature-modulated
detachment and the results confirmed the
availability of fabricating the bioengineered
human corneal endothelium in vitro under
conditioned thermoresponsive supports.
2) Fluorescence resonance energy transfer
(FRET)-based dynamic analysis on pro-
inflammatory cytokines in situ following
spinal cord injury: The team has developed
a quantitative FRET-based methodology
for dynamic monitoring of inflammatory
cytokines in situ, such as TNF-α, following
spinal cord injury; this implementation will
dramatically advance the development of
effective therapeutics for neuron functional
regeneration following spinal cord injury.
iMRI applications integrate various
interventional, surgical, and therapeutic
devices and equipment with a diagnostic
MR imaging system so as to increase the
accuracy of various procedures under real-
time MR imaging guidance. In the first
stage, the team focused on MRI-guided
thermal ablation and interventional biopsy
procedures, successfully integrating an animal
research platform for MR guided HIFU (High
Intensity Focused Ultrasound) ablation that
is compatible with 3T MRI system. The team
filed 5 patent disclosures and developed a
prototype for the treatment of uterine fibroids
including a set of MR-compatible HIFU probes.
The accomplishments have established a
successful model for the development of
medical devices in Taiwan.
8. Gerontology Research
1) Immunopathogenesis of osteoarthritis — the
mechanisms and the therapeutic approaches:
The team found that retinoic acid (t-RA) can
suppress IL-1-induced iNOS, COX-2, and
chemokines production, which indicates that
retinoic acid might be able to protect joints
from inflammation induced cartilage damage;
the team also found that Ginkgo biloba extracts
(EGb) preserve immunomodulatory effects
in human chondrocytes, mediated through
suppression of activator protein 1 (AP-1) signal
pathway; these potential immunomodulatory
drugs might be useful for clinical treatment of
osteoarthritis patients.
2) Skeletal progenitor cell defects and tissue
repair in aging: The team's previous study
showed that local infusion of IGF-I in old rats
can strengthen bone formation; combining
IGFBP-3 or IGFBP-5 with IGF-1 can further
enhance the effect; the team further explored
the effect of IGFBP on old osteoprogenitor
cells, and found that PPAR-γ elevation in
aging bones might be responsible for the
preference of adipogenesis at the expense
of osteogenesis, but Wnt10b can repress
the expression of PPAR-γ and reverse this
phenomenon; Wnt10b can also elevate the
expression of Runx2, Dlx5, Osterix factors,
and it is considered to be a viable agent for
reversing age-related decline in bone-formation
capacity.
9. Mental Health Research
1) Epidemiologic study of psychotropic drugs:
The study indicates that individual, service
provider-, and pharmacological characteristics
all play a significant role on the occurrence
of long-term use of Benzodiazepines (BZDs).
Males, elderly, and those with physical or
mental disorders were more likely to become
long-term users of BZDs. Having received
BZD prescriptions in multiple pharmacological
agents, short-acting or mixed-type agents,
and hypnotic indication were associated with
a roughly 2- to 5- fold increased risk of BZD
long-term use (LTU) soon after prescription
initiation. With respect to discontinuation, the
effects of pharmacological characteristics seem
more salient as compared to those of individual
and service-provider factors. Future strategies
targeting individual factors and modifying
service-provider prescription behaviors may
be considered to reduce possible negative
consequences of BZD LTU.
2) Psychogenomic study on the interaction
between antipsychotics and smoking
abstinence medication: The results suggest
the response to a nicotine skin patch may
be associated with one's polymorphism of
genotypes CYP2C9, CYP2C19, and CYP2D6.
3) T h e r a p e u t i c d r u g m o n i t o r i n g a n d
pharmacogenomics in psychiatry: In an anti-
depressant study, the preliminary results
suggest that the ABCB1 gene relating to
escitalopram drug distribution is associated
with the severity of depression; a single
nucleotide polymorphism within the gene
showed high plasma escitalopram drug
concentrations with less remitter than the non-
remitter; this indicates that the plasma drug
concentration alone may not be a sufficient
indicator to predict the treatment outcome; the
genetic variations need to be considered for
Science and Technology Research 111
 the individual treatment response.
10. Stem Cell Research
1) A novel FGF1-containing biomaterial nerve
conduit — fabrication and in vivo evaluation:
FGF1 can be grafted on the polylactide
nerve conduit with the assistance of plasma
treatment; the technique prolonged the
release of growth factor from the conduit;
the novel conduit containing FGF1 promotes
nerve regeneration and can be used to treat
peripheral nerve injury and other neural
diseases.
2) P D M C s f u r t h e r i m m u n e p r o f i l i n g a n d
chondrogenic differentiation in animal arthritis
models: The team isolated human term
placenta-derived multipotent cells (PDMCs),
which later were differentiated into cells from
all 3 germ-layers under the proper conditions;
PDMCs were also found harboring significant
immune suppressive effects, which may
prevent transplantation rejection; the isolation
method developed was granted a patent
in 2008 and is currently under technology
transfer; animal studies on immune reaction
112 2009 Taiwan Public Health Report
and chondrogenesis are ongoing; the PDMCs
cells are expected to have the potential to be a
source of progenitor/stem cells for therapeutic
use.
3) Immuno-modulatory activities of human
umbilical cord blood-derived mesenchymal
stem cells are mediated by transforming growth
factor beta-1 (TGF-β1): The study found that
the addition of TGF-b1 into T cell cultures
exerted the same responses in the absence of
uMSCs; neutralizing antibody against TGF-β1
ameliorated the inhibitory effects of uMSCs;
taken together, uMSCs induce CD4+CD25+
regulatory T cells and modulate the immune
system by secreting TFF-b1 and activating the
downstream signaling pathways.
11. Vaccine Development
1) M u c o s a l r e c o m b i n a n t v a c c i n e s a g a i n s t
respiratory infectious diseases: The team has
successfully developed several viral vectors,
including adenovirus, measles virus, and
rubella virus for developing mucosal vaccines
against respiratory syncytial virus (RSV); the
adenovirus-based mucosal RSV vaccine can
 effectively induce protective immune responses
and prevent RSV infection in mouse model;
two patent applications from this project have
been filed.
2) Development of dengue vaccines: The team
has developed several dengue vaccine
candidates based on domain III of dengue
E protein; these vaccine candidates can
induce neutralizing antibodies against 4
dengue serotypes and have the potential for a
tetravalent dengue vaccine development.
12. Nanomedicine Research
1) The team has synthesized nano-sized silica
particles with ordered porous structure, which
were designed as a new formulation for oral
drug delivery vehicle; due to the high surface
areas of mesoporous silica nanoparticles
(MSN), large amounts of drug molecules can
be loaded into the nanochannels; a targeting
molecule can be conjugated onto the outside
surface of MSN for selective recognition on
specific target cells or organs.
2) The team has designed a series of mesoporous
silica nanoparticles (MSN) with a controllable
drug release function in GI tract; from the
variation of pH values in different sections of
gastrointestinal tract, the drug molecules can
be well protected in the nanochannels under
acidic pH of stomach fluid, and then the neutral
pH of colon can cause the sustained release
of drug molecules; patents for the technology
have been filed in the United States and
Taiwan; the team has progressively developed
intelligent drug delivery system for in vivo
tracking, and high efficiency of photodynamic
therapy.
13. Immunology Research
1) The team applied molecular methods to
assess the expression profiles of Dusp and
MAP4k in various immune cells such as Th17
and dendritic cells, followed by correlating the
observed dynamic gene expression to related
in vitro functions of these cells; the quantitative
expression profiling analyses were completed;
the team is conducting functional studies of
these immune cells in an attempt to establish
the possible correlation.
2) T h e t e a m u s e d g e n e t i c a p p r o a c h e s t o
generate conventional or conditional targeted
mutations of Dusp and MAP4K knockout mice
to search for potential alterations in immune
cell development or immune response initiation
in these mice, and then study the mechanistic
links between gene ablation and phenotype
expression.
3) The team established flow cytometry platforms
to study surface antigen expressions in in vitro
and in vivo differentiated CD4 T cells to search
for novel CD4 T cell subsets and to enhance
our understanding for CD4 T cell-mediated
immune regulation; the flow cytometry
platforms have been validated empirically and
are already being used to analyze wild type
and various knockout mice.
14. Cardiovascular Medicine Research
1) Protective mechanism for cell survival by
prostacyclin: The team discovered that
activation of PPARδ upregulated 14-3-3ε
expression to maintain endothelial cell survival;
the protective effect is mediated by Bad
sequestration with 14-3-3ε and inhibits Bad
Science and Technology Research 113
 translocation to mitochondria; the protective
pathway provides a potential therapeutic
application for cardiovascular-, stroke-, and
cancer-related diseases.
2) Cysteine-rich protein 2 (CRP2) in vascular
smooth muscle cells (VSMCs): Following
arterial injury, an absence of CRP2 enhances
VSMC migration and increases neointima
formation. Thus, upregulating CRP2
expression in the context of vascular injury
might serve as a protective mechanism against
intimal thickening. The study identified that
transforming growth factor β (TGFβ), a factor
present in the injured vessel wall, significantly
induces CRP2 protein and mRNA expression
in VSMCs and that the CRP2 upregulation by
TGFβ is controlled at the transcriptional level
via a CRE promoter element. Understanding
the transcriptional activation of CRP2 may help
to elucidate the molecular mechanisms that
control VSMC gene expression in vascular
diseases.
3) Study of immune system activated by TLR
ligands: The results suggest that the Hsp90β//
IRF3 dependent pathway plays a central role in
CpG ODN-mediated IFN-α/β production; the
knowledge obtained from this study is crucial
for the development of new preventives and
therapeutics.
15. Health Policy Research
1) Pharmacoeconomic and pharmacoepidemiologic
research on new medical technology/
new drugs: The study has shown that (1)
patients who took Thiazolidinediones, the
new drug for DM, may have the risk of
higher inpatient rate due to cardiovascular
114 2009 Taiwan Public Health Report
diseases; (2) Clopidogrel, the new drug used
for anti-thrombus, is more expensive than the
treatment using aspirin and PPI but doesn't
result in less-adverse gastrointestinal events;
(3) the stool color card screening policy
started from 2002 has effectively reduced the
medical cost of biliary atresia cases; and (4)
the hospitalization rate of the recurrent peptic
ulcer patients who received triple therapy was
lower than those who did not, and the interval
between 2 inpatient incidents was longer.
2) Healthy People 2020: The“Healthy People
2020 White Paper,”the“Healthy People
2020 Executive Report,”and the“Healthy
P e o p l e 2 0 2 0 Te c h n i c a l R e p o r t s ” w e r e
published in 2008, with the latter receiving a
Best Publication Award from the Department of
Health.
3) A study on prevalence, risk factors, medical
utilization and health behavior of chronic kidney
disease in Taiwan: The major findings include
that (1) the prevalence of diabetic nephropathy
for type 2 male diabetic cohort is 30.9%;
regardless of the duration of DM, smokers have
higher risk of developing diabetic nephropathy
than non-smokers (OR = 2.28–8.14); (2) the
incidence of chronic kidney disease for the
participants in the Cardiovascular Disease
Risk Factor Two-Township Study is 11.0%; the
result of a 6-year follow-up study indicated that
the risk factors contributing to chronic kidney
diseases including old age, high triglyceride,
and high uric acid; and (3) the adiponectin
genotype of the CKD high risk group has
shown differences among various ethnicities.
 116︱Table 1 Population Statistics

116︱Table 2 Health and Medical Expenditures

Appendixes
117︱Table 3 Medical Facilities

118︱Table 4 No. of Medical Personnel in Practice

119︱Table 5 Pharmaceutical Affairs

119︱Table 6 Food Sanitation

120︱Table 7 Health and Social Insurance

120︱Table 8 Causes of Death

121︱Table 9 International Comparison

 Health and Vital Statistics
Table1 Population Statistics

Population Composition Life Expectancy

Dependency Population
Population Sex Ratio CBR CDR NIR
Under Above Ratio Density
Year 15-64 (per 100 Total Male Female
15 65 (Persons/
women)
㎞2)
(1,000) % % % % ‰ ‰ ‰ Year Year Year

1995 21,357 23.77 68.60 7.64 45.78 106 15.50 5.60 9.90 74.53 71.85 77.74 590

1996 21,525 23.15 68.99 7.86 44.94 106 15.18 5.71 9.47 74.95 72.38 78.05 595

1997 21,743 22.60 69.34 8.06 44.22 106 15.07 5.59 9.48 75.54 72.97 78.61 601

1998 21,929 21.96 69.79 8.26 43.30 105 12.43 5.64 6.79 75.76 73.12 78.93 606

1999 22,092 21.43 70.13 8.44 42.60 105 12.89 5.73 7.16 75.90 73.33 78.98 610

2000 22,277 21.11 70.26 8.62 42.32 105 13.76 5.68 8.08 76.46 73.83 79.56 616

2001 22,406 20.81 70.39 8.81 42.07 104 11.65 5.71 5.94 76.75 74.06 79.92 619

2002 22,521 20.42 70.56 9.02 41.72 104 11.02 5.73 5.29 77.19 74.59 80.24 622

2003 22,605 19.83 70.94 9.24 40.97 104 10.06 5.80 4.27 77.35 74.77 80.33 625

2004 22,689 19.34 71.19 9.48 40.48 104 9.56 5.97 3.59 77.48 74.68 80.75 627

2005 22,770 18.70 71.56 9.74 39.74 103 9.06 6.13 2.92 77.42 74.50 80.80 629

2006 22,877 18.12 71.88 10.00 39.12 103 8.96 5.95 3.01 77.90 74.86 81.41 632

2007 22,958 17.56 72.24 10.21 38.43 102 8.92 6.16 2.76 78.38 75.46 81.72 634

2008 23,073 16.95 72.62 10.43 37.70 102 8.64 6.25 2.40 (f) 78.5 (f) 75.49 (f) 82.01 637

Notes：1.Economic growth rate is calculated by actual GDP. 2.(f) is Estimates.

Source：Department of Statistics, Ministry of the Interior.

Table 2 Health and Medical Expenditures

Expenditure
Final of DOH and
Net
Annual Expenditure Affiliated
Per Expenditures Medical Consumer
Economic of Health Organizations
Capita of All Health and Expenditures Price Medical
Year Growth Care for % of % of Private as % of
GDP Government Medical as % of GDP Index Expenditure
Rate Private GDP Consumption Total Central
Fiscal Year Expenditures Index
Sector Government
Expenditures

% US＄ NT＄million % % NT＄million % % % 2006=100

1995 6.5 12,906 313,349 4.32 7.43 1,910,066 1.53 0.85 5.32 89.58 76.32

1996 6.3 13,527 355,249 4.47 7.64 1,843,786 1.57 0.78 5.39 92.33 77.60

1997 6.6 13,904 393,237 4.57 7.79 1,878,764 1.51 0.79 5.40 93.17 79.44

1998 4.6 12,679 431,469 4.67 7.94 1,992,593 1.37 0.66 5.48 94.73 80.18

1999 5.8 13,609 469,765 4.87 8.16 2,050,004 1.31 1.15 5.67 94.90 82.96

2000 5.8 14,519 493,863 4.92 8.11 3,140,936 1.28 0.85 5.67 96.09 86.08

2001 -2.2 13,093 516,748 5.24 8.43 2,271,755 1.17 1.07 5.97 96.08 87.23

2002 4.6 13,291 541,498 5.26 8.62 2,144,994 1.29 1.10 5.95 95.89 88.36

2003 3.5 13,587 561,720 5.34 8.84 2,206,223 1.53 1.14 6.09 95.62 91.29

2004 6.2 14,663 586,389 5.30 8.73 2,238,904 1.46 1.15 6.04 97.17 93.09

2005 4.2 15,714 615,803 5.38 8.77 2,278,439 1.20 1.11 6.01 99.41 96.80

2006 4.8 16,111 640,471 5.37 8.92 2,232,586 1.39 1.44 6.14 100.00 100.00

2007 5.7 16,855 672,408 5.32 9.03 2,296,077 1.45 1.61 6.13 101.80 103.91

Source：Annual Financial Report, Ministry of Finance.

116 2009 Taiwan Public Health Report

Table 3 Medical Facilities

Medical Care Institutions

Hospitals
Clinics
Western Medicine Chinese Medicine
Year
Western Chinese
Public Private Public Private Dentistry
Medicine Medicine

No. No. No. No. No. No. No. No. No. No. No. No.

1995 16,109 787 688 94 594 99 1 98 15,322 8,683 1,933 4,706

1996 16,645 773 684 94 590 89 1 88 15,872 9,009 1,987 4,876

1997 17,398 750 667 95 572 83 2 81 16,648 9,347 2,165 5,136

1998 17,731 719 647 95 552 72 2 70 17,012 9,473 2,259 5,280

1999 17,770 700 634 96 538 66 2 64 17,070 9,378 2,317 5,375

2000 18,082 669 617 94 523 52 2 50 17,413 9,402 2,461 5,550

2001 18,265 637 593 92 501 44 2 42 17,628 9,425 2,544 5,659

2002 18,228 610 574 91 483 36 2 34 17,618 9,287 2,601 5,730

2003 18,777 594 558 91 467 36 2 34 18,183 9,565 2,729 5,889

2004 19,240 590 556 88 468 34 2 32 18,650 9,819 2,852 5,979

2005 19,433 556 531 79 452 25 1 24 18,877 9,948 2,900 6,029

2006 19,682 547 523 79 444 24 1 23 19,135 10,066 3,006 6,065

2007 19,900 530 507 79 428 23 1 22 19,370 10,197 3,069 6,104

2008 20,174 515 493 79 414 22 1 21 19,659 10,326 3,160 6,173

Source：Office of Statistics, Department of Health

Table 3 Medical Facilities (Continued)

Hospitals by Accreditation

New Hospital New Hospital

District New Hospital New Hospital
Medical Regional District Psychiatric Accreditation Accreditation
Year Teaching Accreditation Accreditation-
Centers Hospitals Hospitals Hospitals of Psychiatry- of Psychiatry-
Hospitals -Excellent Qualified
Excellent Qualified

No. Beds No. Beds No. Beds No. Beds No. Beds No. Beds No. Beds No. Beds No. Beds

1995 14 19,375 44 22,342 505 44,750 63 15,860 … … … … 30 8,368 … … … …

1996 14 19,919 45 24,099 479 44,369 68 18,463 … … … … 28 8,126 … … … …

1997 16 22,151 51 28,282 468 42,834 69 17,514 … … … … 26 8,348 … … … …

1998 17 23,405 51 28,974 469 44,621 67 18,143 … … … … 27 8,395 … … … …

1999 18 24,555 51 27,883 426 42,327 66 18,446 … … … … 32 8,709 … … … …

2000 23 27,473 63 33,820 387 36,080 49 13,277 … … … … 32 9,399 … … … …

2001 24 28,389 66 35,381 401 36,104 47 13,168 … … … … 35 9,703 … … … …

2002 23 29,398 71 40,761 385 35,860 41 11,468 … … … … 36 9,450 … … … …

2003 23 30,301 72 42,158 372 34,922 42 11,765 … … … … 37 10,493 … … … …

2004 24 31,195 72 43,628 359 35,952 42 12,594 … … … … 37 10,879 … … … …

2005 22 30,552 64 39,536 352 38,584 41 13,453 … … … … 38 11,153 … … … …

2006 24 31,786 55 37,616 344 37,602 37 11,961 - - 15 7,198 37 11,176 - - - -

2007 23 32,439 20 14,970 306 28,254 23 7,714 24 15,979 59 24,683 29 7,239 7 3,537 4 1,092

2008 17 22,565 - - 208 16,129 8 2,189 51 35,435 146 33,610 3 1,006 7 3,537 30 7,473

Notes：New Hospital Accreditation System was implemented in 2006.

Source：Office of Statistics, Department of Health.

Appendixes 117
 Table 3 Medical Facilities (Continued)

Health Stations No. of Beds Per 10,000 population

No. of Beds in Hospitals No. of Hospital Beds

Kao-
Taiwan Taipei Kinmen Observation Acute Acute Chronic Chronic
Year hsiung Special Hemodialysis Clinics
Province City Matsu Public Private Beds in general psychiatric general psychiatric
City beds beds
Clinics beds beds beds beds

No. No. No. No. No. Beds Beds Beds Beds Beds Beds Beds Beds Beds Beds Beds Beds Beds

1995 369 338 12 11 8 112,379 101,430 39,922 61,508 10,949 52.78 30.12 1.22 2.38 5.01 7.16 1.76 5.13

1996 369 338 12 11 8 114,923 104,111 40,125 63,986 10,812 53.39 30.61 1.59 2.18 4.49 7.60 1.90 5.02

1997 369 338 12 11 8 121,483 108,536 41,421 67,115 12,947 55.87 30.46 1.73 2.38 4.71 8.58 2.06 5.95

1998 369 338 12 11 8 124,564 111,941 42,838 69,103 12,623 56.80 30.98 1.80 2.29 5.11 8.76 2.10 5.76

1999 369 338 12 11 8 122,937 110,660 39,440 71,220 12,277 55.65 30.84 2.10 2.28 3.93 8.63 2.32 5.56

2000 369 338 12 11 8 126,476 114,179 40,129 74,050 12,297 56.77 31.03 2.25 2.40 4.38 8.61 2.59 5.52

2001 363 332 12 11 8 127,676 114,640 39,670 74,970 13,036 56.99 30.27 2.27 2.17 4.44 9.24 2.77 5.82

2002 363 332 12 11 8 133,398 119,847 41,904 77,943 13,551 59.24 30.89 2.37 2.19 4.70 10.13 2.93 6.02

2003 372 340 12 12 8 136,331 121,698 42,777 78,921 14,633 60.31 30.77 2.46 1.91 4.89 10.74 3.08 6.47

2004 372 339 12 12 9 143,343 127,667 43,865 83,802 15,676 63.18 31.87 2.59 1.95 5.13 11.55 3.19 6.91

2005 372 339 12 12 9 146,382 129,548 44,273 85,275 16,834 64.29 31.80 2.64 1.94 5.51 11.75 3.26 7.39

2006 372 339 12 12 9 148,962 131,152 44,076 87,076 17,810 65.12 31.88 2.65 1.83 5.71 11.87 3.39 7.79

2007 372 339 12 12 9 150,628 131,776 44,873 86,903 18,852 65.61 31.94 2.77 1.75 5.78 11.52 3.48 8.21

2008 372 339 12 12 9 152,901 133,020 45,450 87,570 19,881 66.37 31.87 2.86 1.71 5.93 11.69 3.53 8.63

Source：Office of Statistics, Department of Health.

Table 4 No. of Medical Personnel in Practice

No. of Medical Care Personnel

Population
Served per Medical
Population Population Medical
Chinese Physician Population Radiological
Pharmaceutical Served per Nursing Served per Technologists
Year Physicians Medicine (including Dentists Served per Technologists Dietitians
Personnel Pharmaceutical Personnel Nursing (Including
Doctors Chinese Dentist (including
Personnel Personnel Assistants)
Medicine Technicians)
Doctors)

No. No. No. No. No. No. No. No. No. No. No. No. No.

1995 118,242 24,465 3,030 777 7,026 3,040 19,224 1,111 57,585 371 4,722 1,793 298

1996 123,829 24,790 2,992 775 7,254 2,967 19,667 1,094 62,268 346 5,034 1,453 293

1997 137,829 25,730 3,299 749 7,573 2,871 21,246 1,023 70,447 309 5,389 2,266 515

1998 144,070 27,168 3,461 716 7,900 2,776 22,761 963 71,919 305 5,583 2,485 575

1999 152,385 28,216 3,546 696 8,240 2,681 23,937 923 76,252 290 6,015 2,500 656

2000 159,212 29,585 3,733 669 8,597 2,591 24,404 913 79,734 279 6,230 2,761 743

2001 165,855 30,562 3,979 649 8,944 2,505 24,891 900 83,281 269 6,542 3,152 778

2002 175,444 31,532 4,101 632 9,206 2,446 25,355 888 90,058 250 6,725 3,410 845

2003 183,103 32,390 4,266 617 9,551 2,367 25,033 903 95,747 236 7,055 3,557 895

2004 192,611 33,360 4,588 598 9,868 2,299 26,079 870 101,924 223 7,122 3,704 978

2005 199,734 34,093 4,610 588 10,141 2,245 26,750 850 105,183 216 7,323 3,880 1,056

2006 206,959 34,899 4,743 577 10,412 2,197 27,412 835 109,521 209 7,457 4,052 1,137

2007 214,748 35,849 4,862 567 10,740 2,138 28,040 819 114,179 201 7,642 4,211 1,239

2008 223,623 37,142 5,112 545 11,093 2,077 28,741 802 119,093 193 7,896 4,443 1,379

Source：Office of Statistics, Department of Health.

118 2009 Taiwan Public Health Report

Table 5 Pharmaceutical Affairs

No.of Pharmaceutical Firms

Pharmacies Medicine Dealers Pharmaceutical Manufactures

Owned and
Year Owned and
Operated Western Chinese Medicial Western Chinese Medicial
Operated by
by Assistant Medicines Medicines Devices Medicines Medicines Devices
Pharmacists
Pharmacists

Store Store Store Store Store Store Store Store Store Store

1995 34,846 4,862 2,386 2,476 9,074 9,631 10,609 253 249 168

1996 37,176 6,438 3,243 3,195 7,563 9,585 12,948 242 238 162

1997 38,583 6,707 3,443 3,264 7,020 9,123 15,098 243 218 174

1998 39,027 6,434 3,436 2,998 6,466 9,217 16,262 243 217 188

1999 40,322 6,349 3,422 2,927 6,457 9,229 17,627 244 208 208

2000 43,641 6,397 3,491 2,906 6,359 11,161 19,016 243 207 258

2001 47,130 6,440 3,600 2,840 6,524 12,864 20,560 257 202 283

2002 49,752 6,990 3,983 3,007 6,526 13,202 22,268 244 200 322

2003 51,447 7,155 4,193 2,962 6,751 12,799 23,950 243 171 378

2004 52,685 7,435 4,465 2,970 6,759 12,712 24,924 244 171 440

2005 55,802 7,673 4,691 2,982 6,875 12,682 27,641 241 150 540

2006 57,976 7,397 4,598 2,799 6,941 12,577 30,062 238 129 632

2007 59,061 7,381 4,663 2,718 6,848 12,505 31,280 244 121 682

2008 58,834 7,251 4,628 2,587 6,630 12,234 31,650 245 111 749

Notes：No. of pharmacies in 2008 includes 2,411 part-time Chinese medicine dealers.

Source：Office of Statistics, Department of Health.

Table 6 Food Sanitation

Laboratory Testing for Inspections for Food Sanitation Establishments Incidents of Food Poisoning
Food Sanitation

Year Disqualified No.of No.of

Disqualified
To be Improved Fined Suspended Cases Deaths

Piece % Store Store % Store % Store % Piece Person Person

1995 40,410 10.51 237,189 20,390 8.60 1,316 0.55 6 0.00 123 4,950 -

1996 38,475 10.11 210,942 22,229 10.54 2,903 1.38 95 0.05 178 4,043 -

1997 38,606 10.49 197,042 16,582 8.42 1,051 0.53 29 0.15 234 7,235 1

1998 38,141 8.72 179,485 16,821 9.37 1,035 0.58 34 0.02 180 3,951 -

1999 37,773 8.09 181,818 19,020 10.46 37 0.02 10 0.01 150 3,112 1

2000 67,020 4.42 181,865 20,363 11.20 152 0.08 8 0.00 208 3,759 3

2001 34,907 8.56 166,195 20,069 12.08 104 0.06 59 0.04 178 2,955 2

2002 33,971 8.57 158,583 15,978 10.08 69 0.04 9 0.01 262 5,566 1

2003 36,220 10.06 177,102 15,525 8.77 104 0.05 8 0.00 251 5,283 -

2004 37,158 6.89 150,698 13,426 8.91 118 0.07 10 0.00 274 3,992 2

2005 39,395 6.36 182,575 15,218 8.34 51 0.03 5 0.00 247 3,530 1

2006 39,539 … 165,208 24,376 14.75 108 0.07 19 0.01 265 4,401 -

2007 38,729 … 156,794 27,769 17.71 94 0.06 11 0.01 240 3,223 -

2008 43,545 6.04 143,779 34,177 23.77 65 0.05 81 0.06 269 2,921 -

Source：Office of Statistics, Department of Health.

Appendixes 119
 Table 7 Health and Social Insurance

No. of Outpatient
No.of Persons Under No. of Inpatients per Average Costs Per Average Costs Per Average Days of
Visits per 100 Insured
Social Insurance 100 Insured persons Outpatient Visit Inpatient Care Hospital Stay
Persons

Year As % of Total National Health National Health National Health National Health National Health
Population Insurance Insurance Insurance Insurance Insurance

1000
% No. No. No. No. No.
Persons

1995＊ 19,123 89.54 1,055.81 10.14 530 29,418 9.41

1996 20,041 93.11 1,360.89 11.72 549 31,935 9.03

1997 20,492 94.25 1,431.49 11.61 557 32,760 8.75

1998 20,757 94.66 1,499.66 11.83 588 34,851 8.78

1999 21,090 95.46 1,527.86 12.28 614 36,098 8.68

2000 21,401 96.07 1,472.20 12.57 631 36,478 8.73

2001 21,654 96.64 1,449.86 13.00 659 37,169 8.83

2002 21,869 97.11 1,451.80 13.47 707 39,160 9.05

2003 21,984 97.26 1,432.15 12.44 746 43,343 9.64

2004 22,134 97.55 1,549.52 13.60 776 46,914 9.70

2005 22,315 98.00 1,546.96 13.35 792 49,212 9.86

2006 22,484 98.29 1,467.87 12.95 840 50,216 9.92

2007 22,803 99.32 1,480.50 13.02 857 50,809 10.02

2008 22,918 99.48 1,488.08 13.30 899 51,475 10.24

Notes：＊Date is for March to December only for the year 1995.

Source：Bureau of National Health Insurance.

Table 8 Causes of Death

Cerebrovascular
All Causes Malignant Neoplasms Hart Diseases Pneumonia Diabetes Mellitus
Diseases

Year
Mortality Mortality Mortality Mortality Mortality Mortality
No.of No.of No.of No.of No.of No.of
per Order per Order per Order per Order per Order per
Deaths Deaths Deaths Deaths Deaths Deaths
100,000 100,000 100,000 100,000 100,000 100,000

1995 117,954 554.6 1 25,841 121.5 4 11,256 52.9 2 14,132 66.5 8 3,070 14.4 5 7,225 34.0

1996 120,605 562.5 1 27,961 130.4 4 11,273 52.6 2 13,944 65.0 8 3,200 14.9 5 7,525 35.1

1997 119,385 551.8 1 29,011 134.1 4 10,754 49.7 2 12,885 59.6 7 3,619 16.7 5 7,500 34.7

1998 121,946 558.5 1 29,260 134.0 3 11,030 50.5 2 12,705 58.2 7 4,447 20.4 5 7,532 34.5

1999 124,991 567.9 1 29,784 135.3 4 11,299 51.3 3 12,631 57.4 7 4,006 18.2 5 9,023 41.0

2000 124,481 561.1 1 31,554 142.2 3 10,552 47.6 2 13,332 60.1 8 3,302 14.9 5 9,450 42.6

2001 126,667 567.0 1 32,993 147.7 3 11,003 49.3 2 13,141 58.8 8 3,746 16.8 5 9,113 40.8

2002 126,936 565.1 1 34,342 152.9 3 11,441 50.9 2 12,009 53.5 7 4,530 20.2 4 8,818 39.3

2003 129,878 575.6 1 35,201 156.0 3 11,785 52.2 2 12,404 55.0 7 5,099 22.6 4 10,013 44.4

2004 133,679 590.3 1 36,357 160.5 2 12,861 56.8 3 12,339 54.5 6 5,536 24.4 4 9,191 40.6

2005 138,957 611.3 1 37,222 163.8 3 12,970 57.1 2 13,139 57.8 6 5,687 25.0 4 10,501 46.2

2006 135,071 591.8 1 37,998 166.5 3 12,283 53.8 2 12,596 55.2 6 5,396 23.6 4 9,690 42.5

2007 139,376 608.2 1 40,306 175.9 2 13,003 56.7 3 12,875 56.2 6 5,895 25.7 4 10,231 44.6

2008 142,283 618.7 1 38,913 169.2 2 15,726 68.4 3 10,663 46.4 4 8,661 37.7 5 8,036 34.9

Notes：Data organized by ICD-10 since 2008

Source：Office of Statistics, Department of Health .

120 2009 Taiwan Public Health Report

Table 8 Causes of Death (Continued)

Accidents and adverse Chronic diseases of lower Chronic liver diseases Suicide and Self Inflicted Nephritis, nephrotic
effects respiratory tract and cirrhosis Injury syndrome and nephrosis
Year Mortality Mortality Mortality Mortality Mortality
No.of No.of No.of No.of No.of
Order per Order per Order per Order per Order per
Deaths Deaths Deaths Deaths Deaths
100,000 100,000 100,000 100,000 100,000

1995 3 12,983 61.1 … 4,017 18.9 6 4,456 21.0 11 1,618 7.6 7 3,519 16.6

1996 3 12,422 57.9 … 4,310 20.1 6 4,610 21.5 11 1,847 8.6 7 3,547 16.5

1997 3 11,297 52.2 … 4,457 20.6 6 4,767 22.0 10 2,172 10.0 8 3,504 16.2

1998 4 10,973 50.3 … 4,961 22.7 6 4,940 22.6 10 2,177 10.0 8 3,435 15.7

1999 2 12,960 58.9 … 5,046 22.9 6 5,180 23.5 9 2,281 10.4 8 3,474 15.8

2000 4 10,515 47.4 … 4,717 21.3 6 5,174 23.3 9 2,471 11.1 7 3,872 17.5

2001 4 9,513 42.6 … 5,159 23.1 6 5,239 23.5 9 2,781 12.5 7 4,056 18.2

2002 5 8,489 37.8 … 5,226 23.3 6 4,795 21.4 9 3,053 13.6 8 4,168 18.6

2003 5 8,191 36.3 … 5,192 23.0 6 5,185 23.0 9 3,195 14.2 8 4,306 19.1

2004 5 8,453 37.3 … 5,292 23.4 7 5,351 23.6 9 3,468 15.3 8 4,680 20.7

2005 5 8,364 36.8 … 5,484 24.1 7 5,621 24.7 9 4,282 18.8 8 4,822 21.2

2006 5 8,011 35.1 … 4,969 21.8 7 5,049 22.1 9 4,406 19.3 8 4,712 20.7

2007 5 7,130 31.1 … 4,914 21.4 7 5,160 22.5 9 3,933 17.2 8 5,099 22.3

2008 6 7,077 30.8 7 5,374 23.4 8 4,917 21.4 9 4,128 17.9 10 4,012 17.5

Source：Office of Statistics, Department of Health .

Table 9 International Comparison

Life Expectancy Crude Birth Rate

Taiwan Japan USA Germany UK South Korea

South
Year Taiwan Japan USA Germany UK
Korea
Male Female Male Female Male Female Male Female Male Female Male Female

Year Year Year Year Year Year Year Year Year Year Year Year 0 00 0 00 0 00 0 00 0 00 0 00

1995 71.9 77.7 76.4 82.9 72.5 78.9 73.3 79.7 74.0 79.2 69.6 77.4 15.5 9.6 14.8 9.4 12.6 16.0

1996 72.4 78.0 77.0 83.6 73.1 79.1 73.6 79.9 74.3 79.5 70.1 77.8 15.2 9.7 14.7 9.7 12.6 15.3

1997 73.0 78.6 77.2 83.8 73.6 79.4 74.0 80.3 74.6 79.6 70.6 78.1 15.1 9.5 14.5 9.9 12.5 14.8

1998 73.1 78.9 77.2 84.0 73.8 79.5 74.5 80.6 74.8 79.8 71.1 78.5 12.4 9.6 14.6 9.7 12.3 13.8

1999 73.3 79.0 77.1 84.0 73.9 79.4 74.7 80.7 75.0 79.8 71.7 79.2 12.9 9.4 14.5 9.4 11.9 13.2

2000 73.8 79.6 77.7 84.6 74.1 79.5 75.0 81.0 75.5 80.2 72.3 79.6 13.8 9.5 14.4 9.3 11.5 13.4

2001 74.1 79.9 78.9 84.9 74.4 79.8 75.6 81.3 75.7 80.4 72.8 80.0 11.7 9.3 14.1 8.9 11.3 11.6

2002 74.6 80.2 78.3 85.2 74.5 79.9 75.6 81.6 75.8 80.5 73.4 80.5 11.0 9.2 14.2 9.0 11.3 10.3

2003 74.8 80.3 77.6 84.4 74.4 80.1 75.5 81.4 75.7 80.7 73.9 80.8 10.1 8.9 14.1 8.6 11.7 10.2

2004 74.7 80.8 78.0 85.0 75.0 80.0 76.0 82.0 76.0 81.0 74.5 81.4 9.6 8.8 14.0 8.5 12.0 9.8

2005 74.5 80.8 78.5 85.5 74.9 80.7 75.7 81.8 75.9 81.0 75.1 81.9 9.1 8.4 13.9 8.4 12.0 9.0

2006 74.9 81.4 78.0 84.7 75.0 80.8 75.8 82.0 76.1 81.1 75.7 82.4 9.0 8.7 14.2 8.2 12.4 9.2

2007 75.5 81.7 … … … … … … … … … … 8.9 … … … … …

2008 (f)75.5 (f)82.0 … … … … … … … … … … 8.6 　 　 　 　 　

Source：WHO (The World Health Report 2005) .

Appendixes 121
Taiwan Public Health Report 2009

Published by the Department of Health, R.O.C. (Taiwan)

No.36, Tacheng St. Datong District, Taipei City 10341,

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First edition. March 2010

Copyright 2010 by the Department of Health, R.O.C. (Taiwan)

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